创伤性胫腓骨骨折术后切口感染的病原菌和危险因素调查

Investigation on pathogens and risk factors of incision infection after traumatic tibiofibular fracture surgery

目的探讨创伤性胫腓骨骨折术后切口感染的病原菌及其危险因素。方法采用回顾性调查方法,对某医院因创伤性胫腓骨骨折而行胫腓骨骨折切开复位内固定术患者的术后切口感染发生情况及病原菌分布状况进行调查,并对相关危险因素进行回归分析。结果398名创伤性胫腓骨骨折的患者术后发生切口感染有33例,切口感染的发生率为8.29%,33例发生切口感染的患者共培养出52株病原菌,其中革兰阳性菌的比例最高(占总菌株数的55.77%);多因素Logistic分析提示:年龄≥60岁、胫腓骨Ⅲ型骨折、开放性骨折、手术时间≥180 min、合并糖尿病以及联用抗菌药物等是创伤性胫腓骨骨折患者术后发生切口感染的危险因素(OR>1,P<0.05),而使用VSD引流是创伤性胫腓骨骨折患者术后避免发生切口感染的保护性因素(OR<1,P<0.05)。结论革兰阳性菌是导致创伤性胫腓骨骨折术后切口感染的主要病原菌,其危险因素明确,应引起我们的重视。

Objective To investigate the pathogens and risk factors of incision infection after traumatic tibiofibular fracture surgery.Methods 398 patients with traumatic tibiofibular fracture who underwent open reduction and internal fixation in our hospital were selected as the research objects.The incidence of incision infection and the distribution of pathogens were analyzed.The risk factors were analyzed by regression analysis.Results Among 398 patients with traumatic tibiofibular fracture,33 had incision infection and the incidence of incision infection was 8.29%.A total of 52 pathogens were cultured in 33 patients with incision infection,of which the proportion of Gram-positive bacteria was the highest(accounting for 55.77%of the total strains).Multivariate Logistic analysis showed that age≥60 years old,type III tibiofibular fracture,open fracture,operation time≥180 min,diabetes mellitus and combined use of antibiotics were the risk factors of incision infection in patients with traumatic tibiofibular fracture after operation(OR>1,P<0.05).VSD drainage was a protective factor to avoid incision infection in patients with traumatic tibiofibular fracture after operation(OR<1,P<0.05).Conclusion Gram-positive bacteria are the main pathogens causing wound infection after operation of traumatic tibiofibular fracture.The risk factors are clear and should be paid attention to.