湖南地区单中心四肢骨干创伤后骨髓炎患者的菌种分布和临床特征分析

Clinical characteristic of limb traumatic osteomyelitis in Hunan China

目的总结湖南地区单中心四肢骨干创伤后骨髓炎患者的临床特征和菌种分布,为创伤后骨髓炎的临床防治提供参考。方法检索中南大学湘雅三医院病例系统近5年(2016年1月1日至2021年3月31日)诊断为四肢骨干创伤后骨髓炎患者的临床特征信息和菌种分布,临床特征包括患者年龄、性别、骨折类型(闭合或者开放)、病灶部位;菌种分布包括微生物培养结果,病灶处微生物种类等,并对收集资料进行归纳整理及统计。结果湖南地区共计有142例四肢骨干创伤后骨髓炎患者,男女比为3.58∶1。创伤后骨髓炎患者创伤后首次发病的中位年龄为47岁(7岁,82岁),造成创伤后骨髓炎的外伤以开放性损伤为主(80.3%)。随访时间大于12月的患者例数为110例,不同手术方案的治愈例数(1年无复发)为93例(84.5%),截肢例数3例(2.7%)。四肢骨干创伤后骨髓炎主要累及下肢,尤其是胫骨。术中取组织标本进行致病微生物培养的阳性例数为83例,阳性率为58.5%。创伤后骨髓炎由单一致病微生物引起感染的例数为75例(90.4%)。根据培养结果发现金黄色葡萄球菌为最常见的微生物(25例,33.3%);其中耐甲氧西林金黄色葡萄球菌10例(13.3%);其次分别为阴沟肠杆菌(10例,13.3%)、铜绿假单胞菌(8例,10.7%)。结论湖南地区四肢骨干创伤后骨髓炎常见于男性,相比于闭合性骨折,开放性骨折更容易导致创伤后骨髓炎,四肢骨干创伤后骨髓炎好发于下肢骨,最常见的致病菌为金黄色葡萄球菌。

【Objective】To analyze the clinical manifestations and bacterial information of limb shaft traumatic osteomyelitis in Hunan China in order to provide a reference for the treatment of traumatic osteomyelitis.【Methods】The case system of the Third Xiangya hospital,Central South University was searched for the data of confirmed limb shaft traumatic osteomyelitis from January 1 st,2016 to March 31 st,2021.The clinical items collected were gender,age of onset,injury type(open or closed),lesion location,intraoperative culture of pathogenic microorganisms,number and type of pathogenic microorganisms,et al.The above data were sorted and analyzed statistically.【Results】A total of 142 patients with limb shaft traumatic osteomyelitis were included.The male to female ratio was 3.58:1 and the average age was 47 years old(7 years old,82 years old).The traumatic osteomyelitis was mostly caused by open injury(80.3%)which mainly affected the lower limbs,especially the tibia.A total of 110 patients were followed up at least one year.The total cure rate was 84.5%and the total amputation rate was 2.7%in the study.The positive rate of intraoperative microorganism culture was 58.5%.90.4%patients were infected by a single pathogenic microorganism.The most common single pathogenic microorganism was Staphylococcus aureus(25 cases)followed by Enterobacter cloacae(10 cases)and Pseudomonas aeruginosa(8 cases).【Conclusion】In Hunan China,more males were prone to limb shaft traumatic osteomyelitis most of which were secondary to an open fracture.Traumatic osteomyelitis usually occurred at a lower limb.The most common pathogenic microorganism was Staphylococcus aureus.