抗菌水凝胶涂层对踝关节骨折术后内植物相关感染的影响

Effect of antibiotic-loaded hydrogel coating in postoperative infection after internal osteosynthesis in ankle fractures

目的探讨内植物使用抗菌水凝胶涂层对踝关节骨折术后感染的影响。方法2016年3月至2019年2月中国人民解放军联勤保障部队第910医院创伤骨科共收治253例闭合性踝关节骨折患者。其中,男110例,女143例;年龄20~77岁,平均(49.3±12.6)岁;骨折AO分型:A型129例,B型112例,C型12例。所有患者按就诊顺序随机分为治疗组和对照组。其中,治疗组126例,术中采用抗菌水凝胶浸泡/涂抹内植物后进行骨折内固定术;对照组127例,采用常规骨折内固定术。记录伤口ASEPSIS评分、伤口感染率、骨折愈合时间、踝关节AOFAS评分、SF-12评分及炎性相关指标。结果所有患者均获得随访,随访时间12~30个月,平均(18.1±4.5)个月。两组间术后7 d、术后14 d ASEPSIS伤口评分比较,差异无统计学意义(P>0.05);治疗组伤口延迟愈合率4.0%,对照组为5.5%,两组间比较差异无统计学意义(P>0.05)。治疗组感染率为0,对照组出现6例伤口感染,感染率4.7%,两组间比较差异有统计学意义(P<0.05)。两组间骨折愈合时间、AOFAS评分和SF-12评分比较,差异无统计学意义(P>0.05)。两组间的血清血沉、C反应蛋白、白细胞计数、中性粒细胞百分比、肌酐、谷草转氨酶、谷丙转氨酶和谷氨酰转肽酶比较,差异无统计学意义(P>0.05)。结论抗菌水凝胶涂层有助于减少踝关节骨折术后内植物相关感染,是一种高效、简便、安全的辅助抗菌手段。

Objective To evaluate the effect of antibiotic-loaded hydrogel coating in postoperative infection after internal osteosynthesis in ankle fractures.Methods Between March 2016 and February 2019,253 patients with close ankle fractures were treated in the 910 th Hospital of Chinese PLA.There were 110 males and 143 females.The average age was(49.3±12.6)years[range 20 to 77 years].According to AO fracture classification,there were 129 cases in type A,112 cases in type B and 12 cases in type C.All patients were divided into treatment group and control group:126 patients in treatment group underwent internal osteosynthesis with antibiotic-loaded hydrogel coating,and 127 patients in control group underwent conventional internal osteosynthesis.ASEPSIS wound score,rate of infection,time of fracture healing,AOFAS score,SF-12 score and indicators of inflammatory were recorded.Results All patients were followed up for(18.1±4.5)months[range 12 to 30 months].After 7 and 14 days,there was no significant difference about ASEPSIS score and rate of delayed wound healing between two groups(P<0.05).The rate of infection was 0 in treatment group and 4.7%in control group,and there was significant difference between the two groups(P>0.05).There was no significant difference between 2 group about time of fracture healing,AOFAS score,SF-12 score and indicators of inflammatory(P>0.05).Conclusion Antibiotic-loaded hydrogel coating can reduce the risk of infection after internal osteosynthesis in ankle fracture,and it is an effective,convenient and safe antibiotic assistant way.