开放性胫骨骨折内固定术后感染的危险因素和病原菌分析

Infection Analysis of Risk Factors and Pathogenic Bacteria in Patients with Open Tibial Fracture after Internal Fixation

目的探讨开放性胫骨骨折内固定术后感染的危险因素和病原学分析。方法选取重庆市开州区人民医院骨科2010年1月—2017年6月收治的开放性胫骨骨折412例,根据是否发生术后感染,分为感染组23例和非感染组389例,观察2组的主要临床特征,分析术后感染的危险因素和病原学。结果感染组体重指数(BMI)≥25 kg/m2、血清白蛋白<30 g/L和合并糖尿病比例高于非感染组(P <0. 05)。多因素logistic回归分析显示,BMI≥25 kg/m2、血清白蛋白<30 g/L和合并糖尿病是开放性胫骨骨折内固定术后感染的危险因素(P <0. 05)。感染组病革兰阴性菌占60. 87%,以铜绿假单胞菌为主。结论 BMI≥25 kg/m2、血清白蛋白<30 g/L、合并糖尿病是开放性胫骨骨折内固定术后感染的危险因素,感染病原菌以革兰阴性菌较为常见。

Objective To analyze risk factors and etiology of infection in patients with open tibial fractures after internal fixation. Methods A total of 412 patients with open tibial fractures admitted during January 2010 and June 2017 were divided into infection group （ n =23） and non-infection group （ n =389） according to whether or not having postoperative infection. Mainly clinical characteristics were observed, and risk factors and etiology of postoperative infection were analyzed in two groups. Results Ratios of body mass index （BMI） equal or larger than 25 kg/m 2, albumin less than 30 g/L and combination of diabetes in infection group were significantly higher than those in non-infection group （ P 〈0.05）. Multiple factor Logistics regression analysis showed that BMI equal or larger than 25 kg/m 2, albumin less than 30 g/L and combination of diabetes were risk factors of postoperative infection in patients with open tibial fractures after internal fixation （ P 〈0.05）. In infection group, gram-negative bacteria accounted for 60.87%, and the most common pathogenic bacteria was pseudomonas aeruginosa. Conclusion BMI equal or larger than 25 kg/m 2, albumin less than 30 g/L and combination of diabetes are risk factors of postoperative infection in patients with open tibial fractures after internal fixation, and the infected pathogenic bacteria is mainly gram-negative bacteria.