胫腓骨开放性骨折患者术后感染病原菌分布及VSD治疗对微循环与相关血清细胞因子指标水平的影响  

Postoperative infection pathogenic bacteria distribution and influence of VSD treatment on microcirculation and relevant serum cytokine indexes of patients with open fractures of tibia and fibula

作　　者：徐清平 宋登峰[1] 王金 陈然峰[2] 何剑星[1] 

机构地区：[1]武警浙江总队杭州医院骨一科,浙江杭州310000 [2]武警浙江总队杭州医院检验科,浙江杭州310000

出　　处：《中华医院感染学杂志》2017年第24期5642-5645,共4页Chinese Journal of Nosocomiology

基　　金：浙江省中医药科技计划基金资助项目(2014ZB124)

摘　　要：目的研究分析胫腓骨开放性骨折患者术后感染病原菌情况及应用负压封闭引流技术(VSD)治疗后患者的血清细胞因子指标水平变化及对患肢微循环恢复作用。方法选取2014年1月-2017年1月医院收治的胫腓骨开放性骨折术后出现感染者62例为A组;另选取同期开放性胫腓骨骨折术后未感染者62例为B组;两组均行内固定或外固定支架治疗,根据术后骨折感染的治疗方法不同将A组分为A1、A2患者各31例,A2患者术后行抗感染药物常规治疗,同时行骨折创面消毒及无菌敷料更换等,A1患者行VSD治疗;观察骨折术后感染的病原菌分布;比较分析A、B两组的细胞间黏附因子-1、可溶性血管细胞黏附因子-1、核因子KB的指标水平;比较A1、A2患者的相关指标水平检测,同时评估临床疗效。结果 62例感染患者共分离出病原菌119株,以革兰阳性菌73株占61.34%为主;治疗后2d、4d、6d,A1患者的流态积分、管襻积分、襻周积分、总积分、白微栓率、管襻畸形率低于A2组,而A1组的襻顶血管直径、管襻长度均高于A2组(P<0.05)。结论对于开放性胫腓骨骨折术后感染患者行VSD治疗,可有效清除骨折区域坏死组织及控制感染,对创面的愈合、肢体微循环修复作用显著。OBJECTIVE To investigate and analyze postoperative infection pathogenic bacteria distribution condition of patients with open fractures of tibia and fibula and influence of vacuum sealing drainage（VSD）on serum cytokine indexes changes and microcirculation recovery effect of patients.METHODS A total of 62 patients with postoperative infections of open fractures of tibia and fibula that had been hospitalized in our hospital from Jan.2014 to Jan.2017 were included in group A,and 62 patients without postoperative infection of open fractures of tibia and fibula of the corresponding period were included in group B.Patients from both groups received internal fixation and external fixation support treatment.According to different treatment methods for postoperative fracture infections,group A were divided into group A1（31 cases）and group A2（31 cases）by physicians.Patients from group A2 received anti-infection conventional drug treatment and fracture trauma disinfection and sterilized dressing,etc.Patients from group A1 received VSD negative pressure drainage.The pathogenic bacteria distribution condition of fracture postoperative infection was observed.The levels of intercellular adhesion molecules-1,soluble vascular cell adhesion molecule-1,nuclear factor-KB of group A and group B were compared and analyzed,the relevant indexes levels of group A1 and group A2 were compared,and the clinical curative effects were evaluated.RESULTS Totally 119 strains of pathogenic bacteria were separated,which were mainly 73 strains of gram-positive bacteria,accounting for 61.34%.Comparing microcirculation levels of both groups at 2 d,4 d,6 dafter treatment,flow regime score,capillary loop score,perivascular tissue score,total score,microembolus score,and vessel loop deformity rate of group A1 were evidently lower than those of group A2,while loop top vessel diameter and vessel loop length of group A1 were significantly higher than those of group A2（P〈0.05）.CONCLUSIONVSD treatment for patients with postoperative infectio

关 键 词：胫腓骨开放性骨折 术后感染 病原菌 负压封闭引流技术 

分 类 号：R619.3[医药卫生—外科学]