华南地区四肢创伤性骨髓炎患者的临床特征分析

Clinical characteristics of limb traumatic osteomyelitis in South China

目的:总结华南地区创伤区域医疗中心四肢创伤性骨髓炎患者的临床特征。方法:检索南方医科大学南方医院骨科-创伤骨科病例系统,时间范围:2010年1月1日至2019年9月1日,回顾性采集诊断为四肢创伤性骨髓炎患者的临床特征信息,如性别、发病年龄、致伤原因、是否开放、是否多个部位感染、术中组织致病微生物培养结果、致病菌数量与种类以及是否进行截肢等,并对上述信息进行归纳整理及统计。结果:华南地区共计有674例创伤性骨髓炎患者,男女比为4.81∶1。造成创伤性骨髓炎的外伤以开放性损伤为主(64.09%,432/674)。创伤性骨髓炎的主要致伤原因为交通伤(39.51%,211/534)。创伤性骨髓炎以单发感染病灶为主(83.68%,564/674),主要累及下肢:胫骨(53.19%,300/564)、股骨(18.97%,107/564)、跟骨(11.70%,66/564)及其他足部骨(4.61%,26/564)。术中取组织标本进行致病微生物培养的阳性率为65.26%(355/544)。多数创伤性骨髓炎患者由单一致病微生物感染引起(74.65%,265/355),最常见的单一致病微生物为金黄色葡萄球菌(38.11%,101/265),其次为铜绿假单胞菌(20.00%,53/265)。创伤性骨髓炎所致截肢率为3.71%(25/674),整体致残率为4.45%(30/674)。结论:华南地区四肢创伤性骨髓炎好发于男性,多继发于开放性骨折。创伤性骨髓炎最常见的致伤原因是交通伤,好发于下肢骨,最常见的致病微生物为金黄色葡萄球菌。

Objective To characterize limb traumatic osteomyelitis in a regional trauma center in South China.Methods The case system at Division of Orthopaedics and Traumatology,Department of Orthopaedics,Nanfang Hospital was searched for the data of confirmed limb traumatic osteomyelitis from January 1,2010 through September 1,2019.The clinical items collected were gender,age of onset,cause of injury,injury nature(open or closed),infected site(single site or multiple sites),intraoperative culture of pathogenic microorganisms,number and type of pathogenic microorganisms,and amputation.The above data were sorted out and analyzed statistically.Results A total of 674 patients suffered limb traumatic osteomyelitis in South China with a male to female ratio of 4.81∶1.The limb traumatic osteomyelitis resulted mainly from open injury(64.09%,432/674).It was mainly caused by a traffic accident(39.51%,211/534).It was featured by single-site infection(83.68%,564/674).It affected mainly the lower limbs:the tibia(53.19%,300/564),the femur(18.97%,107/564),the calcaneus(11.70%,66/564)and other foot bones(4.61%,26/564).The positive rate of intraoperative microorganisms culture was 65.26%(355/544).In the majority of patients(74.65%,265/355),the traumatic osteomyelitis was caused by infection of a single pathogenic microorganism.The most common single pathogenic microorganism was Staphylococcus aureus(38.11%,101/265),followed by Pseudomonas aeruginosa(20.00%,53/265).The rate of amputation related to traumatic osteomyelitis was 3.71%(25/674),and the overall disability rate was 4.45%(30/674).Conclusions In South China,more males were prone to limb traumatic osteomyelitis.Most cases were secondary to an open fracture and caused by a traffic accident.Traumatic osteomyelitis usually occurred at a lower limb.The most common pathogenic microorganism was Staphylococcus aureus.