骨折内固定术后1年以上发生感染的临床诊治经验

Analysis of clinical experience in diagnosis and treatment of infection over one year after internal fixation of fractures

目的总结骨折内固定术后1年以上发生感染的临床诊治经验,为此类患者的诊疗工作提供参考。方法选取2015年1月至2021年6月金华市中心医院收治的骨折内固定术后感染患者28例作为研究对象,分析其病因、临床表现及临床诊治过程,并总结诊治经验。结果28例患者中,急性感染4例,慢性感染24例。急性感染患者中2例高热伴间歇性寒战,2例急性脓肿伴发热;慢性感染患者主要临床表现为皮肤温度升高、局部疼痛、关节僵硬、局部慢性脓肿、窦道、伤口脓性渗出物。术前12例患者行细菌培养,结果显示6例感染金黄色葡萄球菌,3例感染肺炎克雷伯菌,1例同时感染厌氧菌与链球菌,其余2例培养结果阴性。所有患者均行内固定物取出及清创手术。术后随访11个月~5年,患者炎症指标2~6周恢复正常,末次随访时,所有患者的临床症状均明显改善,皮肤温度正常,局部无红肿及压痛,关节活动顺畅,X线片未见新的骨溶解和骨膜反应。结论骨折内固定术后1年以上发生感染的临床表现复杂,致病菌种类较多,核医学骨显像有助于识别感染,对感染患者给予及时、彻底的清创十分重要。

Objective To summarize the clinical diagnosis and treatment experience of infection over one year after internal fixation of fracture,and provide reference for the diagnosis and treatment of such patients.Methods Twenty-eight patients with infection after fracture internal fixation admitted to Jinhua Central Hospital from January 2015 to June 2021 were selected as the research objects to analyze the etiology,clinical manifestations,clinical diagnosis and treatment process,and to summarize the diagnosis and treatment experience.Results Among the 28 patients,4 cases had acute infection and 24 cases had chronic infection.Among the patients with acute infection,2 cases showed high fever with intermittent chills,and the other 2 cases were acute abscess with fever.The main clinical manifestations of patients with chronic infection were elevated skin temperature,local pain,joint stiffness,local chronic abscess,sinus tract,and wound purulent exudate.Bacterial culture was performed on 12 patients before surgery,and the results showed that 6 cases were infected with Staphylococcus aureus,3 cases with Klebsiella pneumoniae,and 1 case with anaerobic bacteria and streptococcus.The culture results of the other 2 cases were negative.All patients underwent internal fixation removal and debridement.The postoperative follow-up was 11 months to 5 years,and the inflammatory indicators of patients returned to normal at 2 to 6 weeks.At the last follow-up,the clinical symptoms of all patients were significantly improved,the skin temperature was normal,there was no redness and tenderness in local area,the joint movement was smooth,and no new osteolysis and periosteum reaction were found on X-ray films.Conclusion The clinical manifestations of infection more than 1 year after internal fixation of fractures are complex,and there are many kinds of pathogenic bacteria detected.Nuclear medical bone imaging may be more helpful to identify infection,and it is important to timely and thorough debridement for infected patients.