四肢开放性骨折外固定术创口感染的危险因素分析

Analysis of Risk Factors for Wound Infection in Patients with Open Fractures of Extremities after External Fixation

目的探讨四肢开放性骨折患者经外固定术后创口感染的危险因素及预防措施.方法选取行外固定术的255例四肢开放性骨折患者作为研究对象,根据术后创口是否发生感染将其分为感染组(n=61)和非感染组(n=194).取感染组患者创口组织进行细菌培养及鉴定,观察患者创口细菌分布情况,并对造成术后创口感染的危险因素进行多元Logistic回归分析.结果255例患者术后创口感染率为23.92%,其中,48例为浅表感染,13例为深部感染.对感染组进行细菌学分析,发现铜绿假单孢菌、大肠埃希菌占比最大,均在20.00%以上.多元Logistic回归分析结果显示:骨折分度(Ⅲ度)、受伤至医院就诊时间(>6 h)、创口遗留死腔是术后创口感染的危险因素,清创彻底是术后创口感染的保护因素(OR=7.290、4.230、12.500、0.450,P<0.05).结论铜绿假单孢菌、大肠埃希菌是导致四肢开放性骨折患者术后创口感染的主要病原菌;骨折分度Ⅲ度、受伤至医院就诊时间>6 h、创口遗留死腔是术后创口感染的危险因素;清创彻底是术后创口感染的保护因素.

Objective To explore the risk factors and preventive measures of wound infection after external fixation in patients with open fractures of extremities.Method A total of 255 patients with open fractures of the extremities who underwent external fixation were selected.They were divided into infected group(n=61)and non-infected group(n=194)according to whether the wound was infected after operation.The wound tissue of the infected group was taken for bacterial culture and identification,observing the distribution of bacteria in wounds.Multivariate Logistic regression analysis was performed on the risk factors for postoperative wound infection.Results The wound infection rate of 255 patients was 23.92%.Among them,48 cases were superficial infections and 13 cases were deep infections.Bacteriological analysis of the infected group showed that Pseudomonas aeruginosa and Escherichia coli accounted for the largest proportion,both above 20.00%.Multivariate analysis showed that fracture index(degreeⅢ),injury to hospital visit time(>6 h),wound left dead space were the risk factors for wound infection in patients.Debridement was a protective factor for wound infection in patient(OR=7.290,4.230,12.500,0.450,P<0.05).Conclusion The main pathogens of wound infection in patients with open fractures of extremities caused by Pseudomonas aeruginosa,Escherichia coli,fracture indexing is degreeⅢ,injury to hospital visit time>6 h,wound dead space is risk factor for wound infection,debridement is a protective factor for wound infection.