踝关节运动骨折术后感染因素分析

Analysis of factors for a postoperative infection in patients after treatment of a sports-related ankle fracture

目的分析踝关节运动骨折术后感染因素,为临床感染预防提供指导。方法收集340例踝关节运动骨折患者临床资料,并对切口分泌物样本进行病原菌鉴定。采用卡方经验分析患者临床感染因素。结果患者感染革兰阳性菌18株,革兰阴性菌8株,分别占69.23%和30.77%。革兰阳性菌中,金黄色葡萄球菌为主;革兰阴性菌中,大肠埃希菌为主;金黄色葡萄球菌中,毒力基因sasX、psm-mec、pvl检出率分别为11.11%、22.22%和55.56%。调查的340例患者中,感染患者数31例,感染率为9.12%。分析个人资料对患者术后感染影响发现,性别影响不显著(P>0.05),但年龄和BMI影响显著(P<0.05)。分析个人习惯对患者术后感染影响发现,吸烟史、饮酒史都是影响患者术后感染发生的因素(P<0.05)。基础疾病是影响感染发生的因素(P<0.05)。受伤类型对患者感染发生的影响不显著(P>0.05);但不同能量损伤类型是影响术后感染发生的因素(P<0.05)。血管损伤、神经损伤、多发性损伤、开放性损伤都是影响患者术后感染发生的因素(P<0.05)。术前行跟骨牵引和手术时机是影响感染发生的因素(P<0.05);而术前麻醉方式对患者感染发生影响不显著(P>0.05)。术中出血量、切口类型、切口清洁度都是影响感染发生的因素(P<0.05)。术后负重时间和感染部位是影响患者术后感染的因素(P<0.05)。结论金黄色葡萄球菌是踝关节骨折患者术后感染的主要病原菌类型,毒力基因pvl的高检出率表明其致病能力强,临床抗感染防控中应给予重视。年龄、BMI、个人习惯、基础疾病、手术时机、切口类型、切口清洁度、感染部位等都是影响术后感染发生的危险因素,临床应注意。

Objective To analyze factors for a postoperative infection after treatment of a sports-related ankle fracture in order to guide the clinical prevention of infections.Methods Clinical data on 340 patients who were treated for a sports-related ankle fracture were collected,and pathogens were identified using samples of secretions from the surgical site.Factors for an infection were analyzed using a chi-square test.Results Patients were infected with 18 strains of Gram-positive bacteria(69.23%)and 8 strains of Gram-negative bacteria(30.77%).Staphylococcus aureus was the main Gram-positive bacterium.Escherichia coli was the main Gram-negative bacterium.In S.aureus,the virulence gene sasX was detected at a rate of 11.11%,psm-mec was detected at a rate of 22.22%,and pvl was detected at a rate of 55.56%.Of the 340 patients studied,31 had an infection,for a rate of infection of 9.12%.An analysis of the influence of personal characteristics on development of a postoperative infection indicated that gender had no significant influence(P>0.05),but age and BMI had a significant influence(P<0.05).An analysis of the influence of personal habits on development of a postoperative infection indicated that smoking history and drinking history were factors that affected the incidence of a postoperative infection(P<0.05).Having an underlying condition was a factor affecting the incidence of an infection(P<0.05).The type of injury had no significant effect on the incidence of an infection(P>0.05).However,injury due to different levels of impact was a factor affecting the incidence of a postoperative infection(P<0.05).Vascular injury,nerve injury,multiple injuries,and an open injury were all factors affecting the incidence of a postoperative infection(P<0.05).Preoperative calcaneal traction and operating time were factors affecting the incidence of an infection(P<0.05).However,preoperative anesthesia had no significant effect on the incidence of an infection(P>0.05).Intraoperative blood loss,the type of incision,and incision cleanliness were all factors affecting the incidence of an infection(P<0.05).Postoperative loading time and the site of infection were factors affecting the incidence of a postoperative infection(P<0.05).Conclusion S.aureus is the main bacterium causing a postoperative infection in patients after treatment of a sports-related ankle fracture.The high rate of detection of the virulence gene pvl suggested its potent pathogenicity,and attention should be paid to the clinical prevention and control of infections.Age,BMI,personal habits,an underlying condition,operating time,the type of incision,incision cleanliness,and the site of infection are all risk factors affecting the incidence of a postoperative infection.Attention should be paid to these factors in clinical practice.