跟腱断裂切开修复术后切口感染的影响因素与病原菌分析

Risk factors of incision infection in patients undergoing open surgery for Achilles tendon rupture and bacteriological characteristics

目的探讨跟腱断裂切开修复术后发生切口感染的影响因素及病原学特点。方法回顾性分析2013年1月—2017年12月联勤保障部队第988医院骨科收治的102例跟腱断裂患者。根据是否伴有切口感染分为感染组(16例)与非感染组(86例)。感染组男性13例,女性3例;年龄21~74岁,平均41.4岁;合并系统性红斑狼疮1例,合并类风湿性关节炎1例。术后随访2年以上无不良并发症的非感染组男性79例,女性7例;年龄18~68岁,平均36.0岁。收集患者初次跟腱断裂的伤口情况、术后切口感染情况以及伤口分泌物培养与药敏结果进行比较分析。结果两组患者体质量指数(BMI)、血糖和尿酸方面差异无统计学意义[(24.29±4.20)kg/m^(2)vs.(24.40±2.67)kg/m^(2)、(4.86±0.21)mmol/L vs.(5.05±0.47)mmol/L、(382.94±85.59)μmol/L vs.(391.35±83.93)μmol/L,P>0.05]。感染组有8例(50.0%)为开放性损伤,非感染组3例(3.5%),差异有统计学意义(P<0.001)。感染组吸烟患者占比(8例,50.0%)高于非感染组(16例,18.6%),P=0.017。春季发生初次断裂患者非感染组(45例,52.3%)多于感染组(3例,18.7%),P=0.013。冬季发生初次断裂患者感染组(6例,37.5%)多于非感染组(5例,5.8%),P=0.001。Logistic回归结果提示吸烟(OR=9.616,95%CI:1.725~53.600)以及开放性损伤(OR=53.589,95%CI:7.502~382.788)与跟腱断裂术后发生切口感染有关(P<0.05)。感染组伤口分泌物培养结果提示有5例(31.3%)为金黄色葡萄球菌,7例(43.8%)伤口分泌物培养阴性,2例(12.5%)提示为铜绿假单胞菌,1例(6.2%)提示为路邓葡萄球菌,1例(6.2%)为粪肠球菌。结论跟腱断裂术后切口感染多发生在冬季,吸烟及开放性损伤是切口感染的危险因素,切口病原菌以金黄色葡萄球菌为主。

Objective To retrospectively analyze the influencing factors and bacteriological characteristics of incision infection after open repair of Achilles tendon rupture.Methods This study retrospectively analyzed 102 patients with Achilles tendon rupture admitted to the 988th Hospital of Joint Logistic Support Force from Jan.2013 to Dec.2017.According to whether incisional infection occurred,patients were divided to infection group(n=16)and non-infection group(n=86).In the infection group,there were 13 males and 3 females;their age was 21-74 years with an average age of 41.4 years;there was 1 case of systemic lupus erythematosus and 1 case of rheumatoid arthritis.In the non-infection group,there were 79 males and 7 females,their age was 18-68 years,with an average of 36.0 years.The condition of the wound,incidence of postoperative incision infection,wound secretion culture and drug sensitivity results were collected and analyzed.Results There was no significant difference in BMI(body mass index),blood glucose and uric acid between the two groups[(24.29±4.20)kg/m^(2) vs.(24.40±2.67)kg/m^(2),(4.86±0.21)mmol/L vs.(5.05±0.47)mmol/L,(382.94±85.59)μmol/L vs.(391.35±83.93)μmol/L,P<0.05].Eight(50.0%)patients in the infection group had open trauma,compared with 3(3.5%)patients in the non-infection group,the difference was statistically significant(P<0.001).The number of smokers in the infection group(8 cases,50.0%)was higher than that in the non-infection group(16 cases,18.6%),and the difference was statistically significant(P=0.017).The incidence of primary rupture in spring in the non-infection group(45 cases,52.3%)was higher than that in the infection group(3 cases,18.7%),and the difference was statistically significant(P=0.013).The incidence of primary rupture in winter was significantly higher in the infection group(6 cases,37.5%)than that in the non-infection group(5 cases,5.8%),P=0.001.Logistic regression results suggested that smoking(OR=9.616,95%CI:1.725-53.600)and open injury(OR=53.589,95%CI:7.502-382.788)were associated with incision infection after Achilles tendon rupture(P<0.05).In the infection group,five cases(31.3%)were Staphylococcus aureus,seven cases(43.8%)were negative,2 cases(12.5%)were Pseudomonas aeruginosa,1 case(6.2%)was Staphylococcus lugdunensis,and 1 case(6.2%)was Enterococcus faecalis.Conclusion Incision infection after Achilles tendon rupture mostly occurs in winter.Smoking and open injury are the risk factors of incision infection,and staphylococcus aureus is the main pathogenic bacteria.