骨折术后手术部位感染的诊断及其治疗进展

近年来,随着社会经济的快速发展,外伤所致的开放性、多发性、复杂性骨折病例越来越多,而手术是其主要治疗手段,加之医疗技术的进步和各种新型内固定材料的不断涌现,骨折后接受内固定术的患者日益增多,术后手术部位感染(surgical site infection, SSI)的发生率越来越高。骨折术后感染是常见且严重的并发症,特别是对于开放性的骨折,因皮肤或黏膜破裂、缺损,导致正常的皮肤生理屏障作用消失,骨折断端外露污染,骨折部位软组织挫裂,血管床遭到破坏,周围组织愈合能力及抵抗感染能力减弱,同时术者对于损伤的判断,清创的彻底与否及固定方式的选择等等,都是其易发感染的潜在危险因素。一旦发生术后SSI,轻者导致伤口延迟愈合,重者可形成骨髓炎,甚至需要截肢,尤其对于有植入物的病例,往往导致灾难性后果,不仅会给患者带来肉体的痛苦和经济损失。因此,骨折术后并发感染的早期诊断和预后的判断成为创伤医学及骨科领域一个热点问题。现就四肢骨折术后感染早期诊断中的应用及诊断价值综述如下。

肝素结合蛋白在老年下肢骨折术后合并肺部感染患者中的诊断价值

目的:本研究旨在通过纳入老年下肢骨折手术患者作为研究对象,分析HBP及其联合CRP、WBC、PCT等常规实验室检测指标在老年下肢骨折术后合并肺部感染诊断中的价值,找出最佳诊断模式,为患者早期治疗作出指导。方法:选取2021年05月01日至2023年11月30日期间上饶市人民医院收治的下肢骨折术后合并肺部感染的80例患者资料,将其作为感染组;另选本院同期骨折类型及手术方式相近且未合并肺部感染的35例患者资料,将其作为无感染组。收集所有患者的基本信息(如性别、年龄、吸烟史、高血压及糖尿病史等)、感染组患者病原分析资料、所有患者血液生化指标及血液水平等数据。比较两组患者各项资料差异;根据患者生化指标及HBP水平检测结果绘制应用受试者操作特征曲线(ROC曲线),计算曲线的曲线下面积(AUC),并确定诊断的最佳临界值及其对应的灵敏度、特异度。结果:1) 血液HBP诊断的AUC为0.840,最佳截断值为27.01 ng/mL,敏感度与特异性分别为75.2%、81.6%;2) 血HBP联合血液生化指标WBC、CRP及PCT诊断的AUC为0.935,敏感度与特异性分别为84.9%、90.2%,高于各项指标单一检测(P Objective: The purpose of this study is to analyze the value of HBP and its combination with CRP, WBC, PCT and other routine laboratory indicators in the diagnosis of pulmonary infection after lower limb fracture surgery in elderly patients, find out the best diagnostic model, and provide guidance for the early treatment of patients. Method: The data of 80 patients with pulmonary infection after lower limb fracture surgery admitted to Shangrao People’s Hospital from May 1, 2021 to November 30, 2023 were selected as the infection group. In addition, the data of 35 patients with similar fracture types and surgical methods and without pulmonary infection in our hospital during the same period were selected as the non-infection group. The basic information of all patients (such as gender, age, smoking history, history of hypertension and diabetes, etc.), pathogen analysis data of patients in the infection group, blood biochemical indicators and HBP levels in blood patients were collected. The differences of data between the two groups were compared. The receiver operating characteristic curve (ROC curve) was drawn according to the results of biochemical indicators and HBP levels of patients, and the area under the curve (AUC) of the curve was calculated to determine the best cut-off value and the corresponding sensitivity and specificity. Results: 1) The AUC of blood HBP diagnosis was 0.840, the best cut-off value was 27.01 ng/mL, the sensitivity and specificity were 75.2% and 81.6%, respectively. 2) The AUC of HBP combined with WBC, CRP and PCT was 0.935, and the sensitivity and specificity were 84.9% and 90.2%, respectively, which were higher than those of each index alone (P < 0.05). Conclusion: 1) Both blood HBP have high diagnostic value for pulmonary infection after lower limb fracture surgery in the elderly, and can be used as an important biomarker to assist doctors in accurate diagnosis. 2) The combination of blood HBP and WBC, CRP, PCT and other indicators can further improve the sensitivity and specificity of diagnosis, and reduce the risk of missed diagnosis and misdiagnosis.