开放性胫骨骨折创面感染患者病原菌分布情况及骨折愈合的影响因素分析

Influence of Pathogenic Bacteria Distribution on Fracture Healing in Patients with Open Tibial Fracture Wound Infection

【目的】探讨开放性胫骨骨折创面感染患者病原菌分布情况及对骨折愈合的影响因素。【方法】选取2016年6月至2019年6月在本院就诊的92例开放性胫骨骨折创面感染患者为研究对象,取患者创面感染渗出物进行病原菌鉴定,根据患者自身情况采取对应的内固定治疗。术后随访6个月观察骨折愈合情况,收集并分析开放性胫骨骨折创面感染患者骨折愈合的影响因素。【结果】92例开放性胫骨骨折创面感染患者共分离到119株病原菌,其中79株革兰阴性菌,以大肠埃希菌为主,占40.34%(48/119);40株革兰阳性菌,以金黄色葡萄球菌为主,占16.81%。术后92例患者均获得为期6个月的随访,愈合患者69例,骨折愈合率75.00%。单因素分析结果显示:年龄、骨折原因、骨折类型、受伤至治疗时间及软组织修复时机是骨折愈合的影响因素(P<0.05);多因素Logistic回归分析结果显示:年龄≥60岁、高能量损伤、骨折分型Ⅱ型、骨折分型Ⅲ型、受伤至治疗时间≥6 h及软组织二期修复是影响开放性胫骨骨折创面感染患者愈合的独立危险因素(OR=2.72、3.36、3.37、1.26、2.16、2.37,P<0.05)。【结论】开放性胫骨骨折创面感染的病原菌主要以大肠埃希菌为主,年龄≥60岁、高能量损伤、骨折分型高、受伤至治疗时间≥6 h及软组织二期修复是影响开放性胫骨骨折创面感染患者骨折愈合的独立危险因素,其中年龄、骨折原因、骨折分型等是无法改变的,因此,在处理时应在可控制的因素上选择合适的固定方法,尽早闭合创面,促进骨折快速愈合。

【Objective】To explore the influence of pathogenic bacteria distribution on fracture healing in patients with open tibial fracture wound infection.【Methods】From June 2016 to June 2019,92 patients with open tibial fracture wound infection were selected as the research objects.The pathogenic bacteria of the infected exudates were identified,and the corresponding internal fixation treatment was taken according to the patients'own situation.All the patients were followed up 6 months after operation,and the factors that may affect the fracture healing were collected and analyzed.The factors that may affect the fracture healing were analyzed by logistic regression analysis.【Results】A total of 119 strains of pathogenic bacteria were isolated from 92 patients with open tibial fracture.Among them,79 strains were Gram-negative bacteria,mainly Escherichia coli,accounting for 40.34%;40 strains were Gram-positive bacteria,mainly Staphylococcus aureus,accounting for 16.81%.All 92 cases were followed up for 6 months,69 cases healed,the rate of fracture healing was 75.00%.The single factor analysis showed that the factors influencing fracture healing were related to age,fracture cause,fracture type,time from injury to treatment and time of soft tissue repair(P<0.05).Multivariate logistic regression analysis showed that:age≥60 years old,high-energy injury,fracture type III,fracture type II,injury to treatment time≥6 h and secondary repair of soft tissue were independent risk factors(OR=2.72,3.36,3.37,1.26,2.16,2.37,P<0.05).【Conclusion】Escherichia coli is the main pathogen of open tibial fracture wound infection.In addition,age≥60 years old,high-energy injury,high fracture classification,time from injury to treatment≥6h and secondary repair of soft tissue are independent risk factors for fracture healing in patients with open tibial fracture wound infection.Pre-measures should be taken to reduce the risk of delayed wound healing and promote the early recovery of patients.