上下肢开放性骨折创面并发感染的影响因素分析及对策  

Related factors and countermeasures for upper and lower limbs open fracture wounds complicated by infections

作　　者：李驰[1] 金广建[1] 陈雷[1] 杨胜武[1] 

机构地区：[1]温州医学院附属第一医院骨科,浙江温州325000

出　　处：《中华医院感染学杂志》2012年第20期4515-4516,共2页Chinese Journal of Nosocomiology

摘　　要：目的探讨上下肢开放性骨折创面并发感染的影响因素及对策。方法选取2002年3月-2010年10月于医院住院手术治疗的四肢长骨开放性骨折患者276例,其中创面感染89例,为观察组;187例未发生创面感染者为对照组;将两组患者骨折部位、Gustilo损伤分级、损伤原因、受伤后至医院清创时间、院前处理、手术方式等临床资料进行统计评估。结果观察组患者受伤后至清创时间>8h、院前处理不当、感染倾向未及时处理率分别为:71.91%、70.79%、73.03%,对照组分别为:15.51%、21.39%、5.88%,差异均有统计学意义(P<0.05);而在使用髓内钉、使用钢板、使用外固定架等危险因素方面差异无统计学意义。结论受伤后至清创时间>8h、院前处理不当、感染倾向未及时处理均是开放性骨折创面感染的危险因素,应积极采取合理措施,降低患者创面感染的发生率。OBJECTIVE To investigate the related factors and countermeasures for upper and lower limbs open fracture wounds complicated by infections.METHODS A total of 276 patients with long bone open fractures in the hospital for surgical treatment from Mar 2002 to Oct 2010 were chosen as the research objects.There were 89 cases of wound infections set as the observation group and 187 patients without wound infections set as the control group.The fracture site,the Gustilo classification of injury,injury causes,the hospital debridement,pre-hospital treatment,surgery and clinical data for the two groups of patients were taken for statistical evaluation.RESULTS The incidence of the debridement more than 8h after the injury,improper handling of the injury,and not timely processing of the infection tendency were 71.91%,70.79%,and 73.03% in the observation group,which were 15.51%,21.39%,and 5.88% in the control group,the difference was statistically significant（P0.05）.There was no significant difference in the use of intramedullary nails,plate,using the external fixator,and other risk factors.CONCLUSION The debridement more than 8 h after the injury,improper handling before enrollment,and not timely processing of the infection tendency are the risk factors for open fracture wound infections,it is necessary to take reasonable measures to reduce the incidence of the wound infections.

关 键 词：上下肢 开放性骨折 感染 影响因素 对策 

分 类 号：R181.32[医药卫生—流行病学]