骨折内固定术后感染病原菌分布及感染对患者预后的影响

Distribution of pathogens causing postoperative infections in fracture internal fixation patients and influence of infections on prognosis

目的分析骨折内固定术后感染病原菌分布以及感染对患者预后的影响,以期为临床诊疗提供参考。方法回顾性分析2013年1月-2015年6月在医院接受内侧锁定板固定术治疗的胫骨骨折患者的临床资料,将其中35例并发术后感染的患者列为感染组,随机选取40例同期接受治疗但未发生感染的患者为未感染组;另纳入50例同期在医院接受健康体检者为对照组,分析感染组病原菌分布及患者的预后。结果 35例感染组患者中分离致病菌51株,其中革兰阳性菌35株,占68.63%,革兰阴性菌13株,占25.49%;感染组患者中位感染时间为2周,其中有28例接受再次手术治疗;感染组患者外周血C-反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)及降钙素原(PCT)水平均显著高于未感染组及对照组,相比较差异均有统计学意义(P<0.05);Logistics回归分析显示,高龄、合并糖尿病及开放性骨折是导致内固定术后并发感染的独立危险因素(P<0.05)。结论骨折内固定术后感染的病原菌主要为金黄色葡萄球菌,感染导致约80%患者再手术,同时导致全身炎症反应。

OBJECTIVE To investigate the distribution of pathogens causing postoperative infections in fracture internal fixation patients and observe the influence of infections on prognosis of the patients so as to provide guidance for clinical diagnosis and treatment.METHODS The clinical data of the patients with tibial fracture who received internal locking plate fixation in hospitals from Jan 2013 to Jun 2015 were retrospectively analyzed.35 patients who were complicated with postoperative infections were assigned as the infection group,40 patients who received the therapy during the same period but were not complicated with infections were chosen as the non-infection group,and 50 healthy people who received physical examination during the same period were included and set as the control group.The distribution of pathogens causing infections and the prognosis of the patients were observed.RESULTS A total of 51 strains of pathogens were isolated from the 35 patients in the infection group,of which 35（68.63%）were gram-positive bacteria,and 13（25.49%）were gram-negative bacteria.The medial time of infections of the infection group was 2weeks,and 28 patients underwent the reoperation.The levels of peripheral blood C-reactive protein（CRP）,tumor necrosis factor-α（TNF-α）,and procalcitonin（PCT）were significantly higher in the infection group than in the non-infection group and the control group（P〈0.05）.The logistics regression analysis indicated that the advanced age,complication with diabetes mellitus,and open fracture were the independent risk factors for the complication with postoperative infection in the internal fixation patients（P〈0.05）.CONCLUSIONThe Staphylococcus aureus is the predominant species of pathogens causing the postoperative infection in the fracture internal fixation patients,80% of the patients undergo reoperation due to the infections,which results in systemic inflammatory reaction.