胫骨开放性骨折首次清创时间与感染率的相关性研究

发布时间：2018-04-17 20:35

  本文选题：胫骨开放性骨折 + Gustilo分型　； 参考：《河北医科大学》2017年硕士论文

【摘要】：目的:随着社会的不断进步,高能量引起的开放性骨折的发病率也不断上升。如果开放性骨折治疗不当,则成为创伤领域中最棘手的疾病:骨髓炎、骨不连。国内外学者对开放性骨折与感染率的相关性做了大量的临床研究,如:开放性骨折的病因、分型、软组织损伤程度、首次清创时间、清创方式、骨折的处理等方面,其中首次清创时间与感染率的关系一直是研究的焦点,在开放性骨折中,胫骨开放性骨折的发生率高,且具有较高的感染率,给患者、家人、社会带来了沉重的负担,本文旨在探讨胫骨开放性骨折首次清创时间与感染率的相关性。方法:我们对河北医科大学第三医院创伤急救中心自2016年1月1日至2017年3月1日期间收治的胫骨开放性骨折患者进行前瞻性研究,排除标准:合并其他部分开放骨折;多发损伤(ISS评分大于16分);合并恶性肿瘤;合并骨关节畸形;伴有心、脑、肝、肾等慢性疾病;不能确定受伤到清创时间的。依据患者自受伤至进入手术室开始清创的时间,将患者分为A、B两组,A组患者自受伤至进入手术室开始清创的时间为6小时内,B组为6小时外清创,收集这些患者的性别、年龄、骨折类型(Gustilo分型)、受伤至进入手术室开始清创的时间、是否感染(伤口红肿炎性渗出,则复查白细胞、C-反应蛋白、降钙素原及血沉等,如升高,高度怀疑感染则进行分泌物培养,若为阳性即定为感染,若为隐性即定为非感染)等资料。采用SPSS21.0进行统计学分析,比较两组感染率有无统计学差异,来探讨胫骨开放性骨折清创时间与感染率的相关性,计量资料符合正态分布且方差齐者用均数±标准差(X±s)表示,两个独立样本用t检验进行比较;计数资料组用?2检验比较,若总例数少于40或某一格的期望值5则采用Fishers确切概率法,设定P0.05认为差异有统计学意义。结果:河北医科大学第三医院创伤急救中心自2016年1月1日至2017年3月1日期间共收治39例,43处胫骨开放性骨折的患者,车祸伤28例,坠落伤6例,挤压伤1例,刀砍伤2例,其他6例,男性27、女性12人,最大82岁,最小10岁,平均年龄40.05±16.38岁,左侧24例,右侧19例;胫骨上、中、下段分别为4、12、27例,根据Gustilo分型:GustiloⅠ型、GustiloⅡ型、GustiloⅢA型、GustiloⅢB型、GustiloⅢC型分别为1例、18例、8例、10例、6例,有2例截肢的患者均属于GustiloⅢC型,共15例发生感染,感染率为34.9%,细菌培养类型为金黄色葡萄球菌4例、鲍曼不动杆菌3例、肺炎克雷伯菌2例、溶血性葡萄球菌2例、凝固酶阴性葡萄球菌2例、大肠埃希菌1例、阴沟肠杆菌1例。A组年龄最大69岁,最小10岁,平均年龄41.00±17.27岁;B组年龄最大82岁,最小14岁,平均年龄39.48±16.13岁.两组年龄差异无统计学意义(T=0.291,P0.05);根据Gustilo分型:A组GustiloⅠ型、GustiloⅡ型、GustiloⅢ型分别为1例、5例、10例,B组GustiloⅠ型、GustiloⅡ型、GustiloⅢ型分别为0例、13例、14例。两组分型差异无统计学意义(Fisher=2.750,P0.05);A组共16例,6例感染,感染率为37.5%;B组共27例,有9例感染,感染率为33.3%,两组感染率差异无统计学意义(?2=0.077,P0.05);GustiloⅡ型感染率为11.1%,GustiloⅢ型感染率为54.2%,GustiloⅡ/Ⅲ型比较,感染率差异有统计学意义(?2=8.305,P0.05)。结论:胫骨开放骨折清创时间大于6小时不增加感染率,胫骨开放性骨折损伤严重程度才是影响胫骨开放性骨折清创术后感染的重要因素。
[Abstract]:Objective: with the development of society, the high energy caused by open fracture incidence rate is also rising. If the improper treatment of open fracture, it is one of the most intractable diseases in the field of trauma: osteomyelitis, bone nonunion. Domestic and foreign scholars on the open fracture and infection rate of the related clinical research a large number of such as open fracture cause, type, degree of soft tissue injury, the first time of debridement, debridement, treatment and other aspects of fracture, of which the first debridement and the relationship between time and the infection rate has been the focus of research in open fractures, open fractures of the tibia with high incidence rate, and has a high infection rate for patients, family and society a heavy burden, this paper aims to explore the open tibial fracture first debridement time correlation with infection rate of trauma. Methods: we Hebei Medical University third hospital emergency center since 20 16 years from January 1st to March 1, 2017 open tibial fracture patients were prospectively studied. Exclusion criteria: combined with the other part of open fracture; multiple injury (ISS score more than 16 points); malignant tumor; bone and joint deformities; with the heart, brain, liver, kidney and other chronic diseases cannot be determined to clear the injured; a time. According to the patient from the injury to enter the operation room began debridement time, the patients were divided into A, B two groups, A group of patients from the injury to enter the operation room began debridement for 6 hours, B group for 6 hours outside the debridement, collect these patients gender, age, fracture type (Gustilo type), injury to enter the operation room began debridement time, whether infection (wound swelling inflammatory exudation, then review the white blood cells, C- reactive protein, procalcitonin and ESR, such as increased infection is highly suspected of secretion culture, if it is positive definite For infection, that is, if the recessive non infection). The information was statistically analyzed by SPSS21.0, compared with no significant difference between the two groups to discuss the infection rate, debridement of open fractures of the tibia and the infection rate of correlation time, measurement data with normal distribution and variance with mean standard deviation (X + s) said, compared with two independent samples t test; count data set with 2? Test comparison, if the total number of cases is less than 40 or a price expectations of 5 with Fishers's exact test, P0.05 considered statistically significant. Results: the Third Hospital of Hebei Medical University from January 1, 2016 to March 1, 2017 the trauma emergency center during a total of 39 patients treated, 43 patients with open tibial fracture, 28 cases of traffic accident injury, 6 cases of falling injury, crush injury in 1 cases, 2 cases of knifed injury, the other 6 patients, 27 male, 12 female, the oldest 82 years old, the youngest 10 years old, the average age of 40.05 + 1 6.38宀，

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