胫骨平台后外侧柱骨折手术患者发生切口感染的手术室相关因素及对策分析

Analysis of operating room related factors and countermeasures of incision infection in patients with posterolateral column fracture of tibial plateau

目的探讨胫骨平台后外侧柱骨折手术患者发生切口感染的手术室相关因素及对策分析。方法选择2015年1月～2018年6月在我院治疗的胫骨平台后外侧柱骨折的患者383例的临床资料进行回顾性分析,根据术后是否发生切口感染分为感染组(n=36)与非感染组(n=347)。统计切口病原菌分布情况,分析影响患者术后切口感染手术室相关因素,并探讨预防对策。结果 36例患者共分离出病原菌48株。革兰阳性菌比例最高,占66.7%,其中金黄色葡萄球菌构成比最高,其次为表皮葡萄球菌。革兰阴性菌中铜绿假单胞菌是主要菌株,分离出1例真菌。多因素分析结果显示:急诊手术、有参观人员、接台手术、手术时间≥3 h是胫骨平台后外侧柱骨折患者术后切口感染的独立危险因素,而层流室是保护因素(P<0.05)。结论胫骨平台后外侧柱骨折手术患者术后切口感染的手术室相关因素包括急诊手术、有参观人员、接台手术、手术时间≥3 h,应加强手术室相关管理,采取必要的措施,降低术后切口感染风险。

Objective To investigate the operating room related factors and countermeasures of incision infection in patients with posterolateral column fracture of tibial plateau. Methods The clinical data of 383 patients with posterior lateral column fractures of the tibial plateau treated in our hospital from January 2015 to June 2018 were retrospectively analyzed. According to whether the wound infection occurred after operation, the patients were divided into infection group (n=36) and non-infection group (n=347). The distribution of pathogens in the incision was statistically analyzed. And the related factors affecting the incision infection after operation in the patients were analyzed, and the preventive measures were discussed. Results A total of 48 pathogens were isolated from 36 patients. The proportion of Gram-positive bacteria was the highest, accounting for 66.7%, of which Staphylococcus aureus had the highest composition ratio, followed by Staphylococcus epidermidis. Pseudomonas aeruginosa was the main strain in Gram-negative bacteria, and one fungus was isolated. Multivariate analysis showed that emergency surgery, visitor, follow-up surgery, and operation time ≥3 h were independent risk factors for postoperative incision infection in patients with posterolateral column fracture of the tibial plateau, and laminar flow chamber was a protective factor(P<0.05). Conclusion The operating room related factors of postoperative incision infection in patients with posterolateral column fracture of the tibial plateau include emergency surgery, visitor, follow-up surgery, operation time ≥3 h. The management of the operating room should be strengthened and necessary measures should be taken to reduce the risk of infection in the incision after operation.