无菌性和感染性股骨骨不连患者的临床对照研究  

Comparative study of patients with aseptic and septic femoral nonunion

作　　者：张伟[1] 陈华[1] 刘浩[2] 朱正国[1] 张群[1] 张立海[1] 唐佩福[1] ZHANG Wei;CHEN Hua;LIU Hao;ZHU Zhengguo;ZHANG Qun;ZHANG Lihai;TANG Peifu(Department of Orthopedic Surgery, General Hospital of Chinese People＇s Liberation Army, Beij ing 100853;Clinical Pharmacy Research Center, General Hospital of Chinese People＇s Liberation Army, Beijing 100853, China)

机构地区：[1]中国人民解放军总医院创伤骨科,北京100853 [2]中国人民解放军总医院临床药学中心,北京100853

出　　处：《中华骨与关节外科杂志》2018年第2期118-123,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：背景:感染是导致骨折不愈合的重要危险因素。目前临床上主要关注的是游走型细菌对骨折愈合的影响,而生物膜型细菌是否也是其预后危险因素尚缺乏相关的临床报道。目的:比较无菌性和感染性(生物膜型细菌)股骨骨不连患者在骨折愈合率、愈合时间和感染复发率等方面的差异并分析其原因。方法:回顾性分析2015年1月至2016年12月术前体格检查和血清学检验阴性的股骨骨不连患者26例。按照术中细菌学培养结果分为感染组9例和无菌组17例。所有的患者术中均取深部组织进行细菌培养+药敏试验。记录并分析术中细菌学培养结果、敏感抗菌药物选用种类和疗程、术后骨折愈合率、愈合时间和感染复发率。结果:26例中24例获得骨折愈合,骨折愈合率为92%,愈合时间为3~9个月,平均(5.8±1.4)个月。无菌组17例骨折均愈合,愈合时间为3~8个月,平均(5.6±1.4)个月。感染组9例中7例骨折愈合,2例因为感染复发未愈合,骨折愈合率为78%,愈合时间为5~9个月,平均(6.3±1.5)个月。两组在骨折愈合率、愈合时间和感染复发率方面无统计学差异。结论:即使术前体格检查和血清学检验阴性,也应该对所有的骨不连患者进行术中细菌学培养,以最终判断感染是否存在。术后敏感抗菌药物规律治疗,可以提高骨折愈合率,降低术后感染复发率。Background： Infection is an important risk factor for nonunion of the fracture. Presently, the main concern in clinic is the influence of planktonic bacteria on fracture healing. Whether biofilm bacteria are also a prognostic risk factor is lack of relevant clinical reports. Objective： To analyze the differences of fracture healing rate, healing time and infection re- currence rate between aseptic and septic femoral nonunion. Methods： From January 2015 to December 2016, 26 patients with femoral nonunion were analyzed retrospectively, whose preoperative physical examination and inflammatory markers were all negative. According to the intraoperative bacterial culture results, all patients were divided into septic group （n=9） and aseptic group （n=17）. Deep tissues were taken for bacterial culture and drug sensitivity test. The results of bacterial cul- ture, the selection of sensitive antibiotics and the course of treatment, the time of fracture healing, the rate of healing and the rate of infection recurrence were recorded and analyzed. Results： Fracture healing was achieved in 24 patients, with a heal- ing rate of 92% and an average healing time of （5.8±1.4） months. In the aseptic group, all the fractures healed and the aver- age healing time was （5.6±1.4） months. In the septic group, 7 patients had fracture healed, 2 patients had the healing failed because of recurrence of infection, and the healing rate was 78% with the average healing time of （6.3± 1.5） months. There was no statistical difference in fracture healing rate, healing time or infection recurrence rate between the two groups. Con- clusions： The bacterial culture should be carried out in all patients with bone nonunion to determine whether the infection is present despite the negative results of preoperative physical examination and inflammatory markers test, which can guide the subsequent antibiotic therapy, thereby enhancing the rate of fracture healing and reducing the recurrence of postopera- tive infection.

关 键 词：骨折 不愈合 骨折愈合 细菌 

分 类 号：R687.3[医药卫生—骨科学]