开放性胫腓骨骨折术后感染的病原菌分布及VSD联合外固定架治疗的临床疗效分析

发布时间：2018-06-18 14:21

本文选题：开放性胫腓骨骨折 + 术后感染　；参考：《中华医院感染学杂志》2017年06期

【摘要】：目的研究分析开放性胫腓骨骨折术后感染的病原菌分布及VSD联合外固定架治疗后的临床效果,为临床治疗提供参考依据。方法选取2011年12月-2015年12月医院收治的开放性胫腓骨骨折术后感染患者166例,根据数字表法将所有患者平均分为两组,其中联合组(83例)行VSD联合外固定架治疗,常规组(83例)行外固定架联合常规灌注冲洗治疗,两组治疗前,对所有患者进行相关临床资料分析及药物试验,对每例患者在3小时内进行2次标本采集,然后进行常规培养,选取纯菌落并在细菌鉴定仪中进行鉴定。结果 166例开放性胫腓骨骨折患者共分离166株病原菌,其中革兰阳性菌82株占49.40%,革兰阴性菌共61株占36.75%,真菌23株占13.86%;联合组在治疗后的控制感染时间(10.96±2.03)d、创面无菌时间(21.82±11.39)d、骨折愈合时间(6.26±1.08)月、患肢康复时间(15.93±2.75)周均显著少于常规组控制感染时间(22.39±1.17)d、创面无菌时间(42.05±13.73)d、骨折愈合时间(10.54±3.39)月、患肢康复时间(19.47±3.86)周,联合组治疗后优良率显著高于常规组,并发症发生率略低于常规组,比较差异有统计学意义(P0.05)。结论外固定器联合VSD治疗开放性胫腓骨骨折患者术后感染效果显著,有利于患者的恢复,但仍需严格掌握手术指征、清创原则。外固定器安装正确,并选择有效的抗菌药物配合治疗。
[Abstract]:Objective to study the distribution of pathogenic bacteria in postoperative infection of open tibiofibula fracture and the clinical effect of VSD combined with external fixator in order to provide reference for clinical treatment. Methods 166 patients with postoperative infection of open tibiofibula fractures admitted in our hospital from December 2011 to December 2015 were divided into two groups according to the digital table method. 83 patients in the combined group were treated with VSD combined with external fixator. 83 patients in the routine group were treated with external fixator combined with routine perfusion irrigation. Before the treatment, all the patients were analyzed for clinical data and drug test. Each patient was collected twice within 3 hours, and then cultured routinely. The pure colony was selected and identified in the bacteria identification instrument. Results 166 strains of pathogenic bacteria were isolated from 166 patients with open fracture of tibia and fibula. Among them, 82 Gram-positive bacteria accounted for 49.40, 61 Gram-negative bacteria accounted for 36.75 and 23 fungi accounted for 13.86.The infection control time after treatment in the combined group was 10.96 卤2.03 days, wound sterility time was 21.82 卤11.39 minutes and fracture healing time was 6.26 卤1.08months. The recovery time of the affected limb was 15.93 卤2.75 weeks, which was significantly lower than that of the control infection group (22.39 卤1.17 days), the sterile wound time (42.05 卤13.73) days, the fracture healing time (10.54 卤3.39) months, and the recovery time of the affected limb (19.47 卤3.86) weeks. The excellent and good rate of the combined group was significantly higher than that of the routine group. The incidence of complications was slightly lower than that in the routine group, and the difference was statistically significant (P 0.05). Conclusion the effect of external fixator combined with VSD in the treatment of postoperative infection in patients with open tibiofibula fracture is remarkable, which is beneficial to the recovery of the patients, but the operative indication and debridement principle should be strictly grasped. The external fixator is installed correctly and effective antimicrobial agents are selected.
【作者单位】：台州市立医院骨科;台州恩泽医疗中心(集团)浙江省台州医院附属妇产医院妇产科;台州市立医院检验科;
【基金】：浙江省医药卫生科技计划基金资助项目(2012KYA180)
【分类号】：R687.3

【参考文献】