以清创后培养物为指标的开放性骨折创口闭合时机  

Timing of wound closure in open fractures based on cultures obtained after debridement

作　　者：夏羿凡[1] 蒋科[1] 夏先学[1] 陈检文[1] 蒲劲松[1] 付能高[1] 张映波[1] 吴青[1] 

机构地区：[1]川北医学院附属医院骨科,四川南充637000

出　　处：《川北医学院学报》2012年第3期239-242,共4页Journal of North Sichuan Medical College

基　　金：四川省教育厅科研项目(12ZB047)

摘　　要：目的:通过对开放性骨折清创后,根据创口分泌物的微生物培养结果来指导临床中创口的闭合时机。方法:422例开放性骨折患者均进行急诊清创,骨折固定。清创后立即行创口分泌物培养。清创后48 h,拟于闭合创口。如果初始培养结果呈阳性,则不闭合创口而再次清创,再次分泌物培养。重复此过程,直到培养物呈阴性后才闭合创口。结果:422例开放性骨折中,长期随访者共346人。总的深部感染率4.3%。GustiloⅡ型骨折深部感染率为4.0%,Ⅲ型骨折,感染率为5.7%。Ⅲ型骨折中亚型的感染率也存在差异,ⅢA型骨折1.8%,ⅢB型10.6%,ⅢC型20%。糖尿病及较高的身体质量指数需要多次清创,并存在较高的感染率。创口阳性培养后闭合创口并没有增加深部感染风险。结论:与历史对照组相比较,标准化治疗方案深部感染率较低。增加清创次数都必须以降低感染率为目的。Objective：To determine the utility of a prospective protocol with the use of wound cultures obtained after irrigation and debridement as a guide to the timing of wound closure following an open fracture of an extremity. Methods： Four-hundred and twenty- two cases of open fracture patients underwent emergency debridement and fracture fixation. Debridement and wound secretion culture was immediately applied after the line and 48 hours after debridement,to promote wound closure. If the initial culture results were posi- tive,but again not closed,wound debridement,and re-secretion culture was applied. This process was repeated until cultures were nega- tive after wound closure. Results ： of the 422 cases of open fractures,the long-term follow-up was performed on a total of 346 people. The overall rate of deep infection was 4.3%. Gustilo Ⅱ fracture deep infection rate was 4.0% , Ⅲ fracture,infection rate was 5.7%. Type Ⅲ fractures were also different in prevalence of subtypes, Ⅲ A fractures 1.8 % , In B-type 10.6% , Ⅲ c type 20. 0%. Diabetes and high body mass index required repeated debridement, and there was a higher infection rate. Positive culture after wound closure of deep wounds did not increase the risk of infection. Conclusion ： Compared with historical control groups, standardized treatment of deep infection rates are low. Increasing the number of debridement procedures will reduce the infection rate and should be done.

关 键 词：清创术 培养物 开放性骨折 创口闭合 

分 类 号：R683.4[医药卫生—骨科学]