髌骨骨折内固定术后感染的诊治方案选择及疗效分析  

Selection of diagnostic and therapeutic regimens and efficacy analysis for postoperative infection following internal fixation of patellar fractures

作　　者：程晖 杨奇宏 万斌[1] 王锦文 刘晟宇 胡军[1] CHENG Hui;YANG Qihong;WAN Bin;WANG Jinwen;LIU Shengyu;HU Jun(Department of Orthopedics,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,210029;Department of Orthopedics,Nanjing Pukou People′s Hospital of Jiangsu Province,Nanjing,Jiangsu,211899)

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029 [2]江苏省南京市浦口人民医院骨科,江苏南京211899

出　　处：《实用临床医药杂志》2024年第24期77-81,87,共6页Journal of Clinical Medicine in Practice

基　　金：国家自然科学基金项目(82272544)。

摘　　要：目的探讨髌骨骨折内固定术后感染的诊治方案选择策略及疗效。方法回顾性分析12例髌骨骨折内固定术后感染患者的临床资料。结果6例患者在清创手术中完全取除内固定物,术后采用膝关节支具固定;6例患者取除原有内固定物,更换为克氏针固定。3例患者并发化脓性关节炎,均接受膝关节镜灌洗治疗。12例患者均接受细菌培养及宏基因二代测序技术(mNGS)检测,且均通过mNGS成功检测出关键致病菌。所有切口在闭合后2周内达到甲级愈合标准。末次随访时,所有患者骨折愈合良好,Bostman髌骨骨折功能评分为24~29分(平均26.58分),疗效评估结果为优秀7例、良好5例,优良率为100.0%。结论对于早期和延迟期的髌骨骨折内固定术后感染患者,取除内固定物有助于降低感染复发风险。对于合并化脓性关节炎的患者,早期诊断并及时实施膝关节镜下关节清理术及留置灌洗引流管治疗至关重要。Objective To explore the selection strategy of diagnostic and therapeutic regimens and assess the efficacy for postoperative infection following internal fixation of patellar fractures.Methods A retrospective analysis was conducted on the clinical data of 12 patients with postoperative infection after internal fixation of patellar fractures.Results A total of 6 patients underwent complete removal of the internal fixation devices during debridement and were subsequently fixed with knee braces,while the other 6 had their original internal fixation devices removed and replaced with Kirschner wire fixation.Three patients developed septic arthritis and underwent knee arthroscopic lavage treatment.All 12 patients underwent bacterial culture and metagenomic next-generation sequencing(mNGS)testing,and the key pathogenic bacteria were successfully identified by mNGS.All wounds achieved primary healing within 2 weeks after closure.At the final follow-up,all patients exhibited good fracture healing,with Bostman patellar fracture function scores ranging from 24 to 29(mean score of 26.58),and the outcomes were evaluated as excellent in 7 cases and good in 5,resulting in an excellent and good rate of 100.0%.Conclusion For patients with early and delayed postoperative infections following internal fixation of patellar fractures,removal of the internal fixation devices can help reduce the risk of infection recurrence.For patients with concurrent septic arthritis,early diagnosis and timely implementation of arthroscopic joint debridement and irrigation and drainage are crucial.

关 键 词：髌骨骨折 内固定术 术后感染 化脓性关节炎 关节镜 宏基因二代测序技术 

分 类 号：R681.2[医药卫生—骨科学] R619[医药卫生—外科学] R319[医药卫生—临床医学]