胫骨开放性骨折骨外露伴感染的皮瓣转移及灌洗临床研究  

Clinical research of the flap open tibial fractures exposed bone complicated with infections and lavage

作　　者：李新霞[1,2] 

机构地区：[1]泰山医学院附属莱芜医院 [2]莱芜市人民医院骨二科,山东莱芜271100

出　　处：《中华医院感染学杂志》2013年第13期3161-3163,共3页Chinese Journal of Nosocomiology

摘　　要：目的探讨胫骨开放性骨折骨外露伴感染的皮瓣转移后有效地灌洗治疗方法,总结处理措施,以预防并减少感染的发生。方法回顾性分析医院2006年1月-2011年1月收治的92例胫骨开放性骨折骨外露伴感染患者,进行皮瓣转移后并采用灌洗治疗的临床资料,随机将患者分为安尔碘组和生理盐水组两组,安尔碘组58例患者先安尔碘灌洗后敏感抗菌药物灌洗治疗,生理盐水组34例生理盐水灌洗后进行敏感抗菌药物治疗,观察患者经不同灌洗治疗后的感染控制和治愈后的复发情况。结果细菌培养共分离出92株病原菌,主要病原菌依次为金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌、铜绿假单胞菌,分别占41.30%、27.17%、20.65%、10.88%;经安尔碘灌洗治疗的患者治疗1、2、3周后的感染率分别为46.55%、67.24%、98.28%,生理盐水灌洗治疗1、2、3周后的感染率分别为35.29%、47.06%、82.35%,安尔碘灌洗治疗的疗效明显高于生理盐水灌洗治疗,且治愈后随访3个月安尔碘的继发感染率为3.45%,明显低于生理盐水治疗组的17.65%,差异有统计学意义(P<0.05)。结论胫骨开放性骨折骨外露伴感染进行皮瓣转移后的灌洗治疗有助于骨折的康复,且安尔碘疗效较好,值得临床推广。OBJECTIVE To explore to analyze effective the lavage treatment method of flap open tibial fractures exposed bone complicated with infections so as to summarize the treatment measures to prevent and reduce the incidence of infections.METHODS A total of 92cases of patients with flap open tibial fractures exposed bone complicated with infections,who were treated with lavage in the hospital between Jan 2006and Jan 2011,were enrolled in the study,the clinical data of the patients were retrospectively analyzed.The patients were randomly divided into the Anerdian group and the saline group,the 58patients in the Anerdian group was primarily treated with Anerdian for lavage,then the sensitive antibiotics for lavage,while the 34patients in the saline group was firstly treated with saline for lavage,then the use of sensitive antibiotics.The control of infections and the reoccurrence after healing were observed after the different lavage treatment.RESULTS A total of 92strains of pathogens were isolated,among which Staphylococcus aureus,Staphylococcus epidermidis,Escherichia coli,and Pseudomonas aeruginosa were the predominant species of pathogens,accounting for 41.30%,27.17%,20.65%,and 10.88%,respectively.The infection rate of the Anerdian lavage group at one week after the treatment was 46.55%,2weeks 67.24%,3weeks 98.28%,while the infection rate of the saline group at one week after the treatment was 35.29%,2weeks 47.06%,3weeks 82.35%,the clinical efficacy of the Anerdian lavage was significantly higher than that of the saline lavage,and the three-month follow-up showed that the incidence of secondary infections was 3.45% in the Anerdian lavage group,significantly lower than 17.65% in the saline lavage group,the difference was statistically significant（P〈0.05）.CONCLUSIONThe lavage treatment for open tibial fractures with bone exposed with infections is conducive to the rehabilitation of flap fracture,and the Anerdian had better therapeutic effect,which is worthy of the clinical promotion.

关 键 词：胫骨骨折 开放性 骨外露 皮瓣 

分 类 号：R181.32[医药卫生—流行病学]