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  

Distribution of pathogens isolated from open tibiofibular fracture patients with postoperative infection and clinical efficacy of VSD combined with external fixation

作　　者：王海峰[1] 许玲聪 马琴飞[3] 孙灵芬[3] 赵小平[1] 

机构地区：[1]台州市立医院骨科,浙江台州318000 [2]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,浙江台州318000 [3]台州市立医院检验科,浙江台州318000

出　　处：《中华医院感染学杂志》2017年第6期1333-1336,共4页Chinese Journal of Nosocomiology

基　　金：浙江省医药卫生科技计划基金资助项目(2012KYA180)

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(P<0.05)。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。OBJECTIVE To investigate the distribution of pathogens isolated from open tibiofibular fracture patients with postoperative infection and observe the clinical effect of VSD combined with external fixation so as to provide guidance for clinical treatment.METHODS From Dec 2011 to Dec 2015,a total of 166 open tibiofibular fracture patients who had postoperative infection were enrolled in the study and were evenly divided into two groups according to digital talbe method.The combination group（83cases）was treated with VSD combined with external fixation,while the conventional group was given external fixation combined with routine perfusion irrigation.The clinical data of all the enrolled patients were analyzed by clinicians before the treatment,the drug susceptibility testing was carried out,the specimens were collected twice for each patient within 3hours,the routine culture was conducted,and the pure colonies were selected and identified by using bacterial identification system.RESULTS Totally 166 strains of pathogens were isolated from the 166 patients with open tibiofibular fracture,including 82（49.40%）strains of gram-positive bacteria,61（36.75%）strains of gram-negative bacteria,and 23（13.86%）strains of fungi.After the treatment,the time of control of infection of the combination group was（10.96±2.03d）,significantly shorter than（22.39±1.17d）of the conventional group;the time of wound healing of the combination group was（21.82±11.39d）,significantly shorter than（42.05±13.73d）of the conventional group;the time of fracture healing of the combination group was（6.26±1.08m）,significantly shorter than（10.54±3.39m）of the conventional group;the recovery time of limbs of the combination group was（15.93±2.75 w）,significantly shorter than（19.47±3.86w）of the conventional group.The excellence rate of the combination group was significantil higher than that of the conventional group after the treatment,while the incidence rate of complications of the combination group was s

关 键 词：开放性胫腓骨骨折 术后感染 病原菌分布 VSD联合外固定架 

分 类 号：R378[医药卫生—病原生物学]