标题：创伤性胫骨平台骨折术后切口感染的病原菌分布与影响因素分析

      作者：王波 1，王斌 2    1.陕西省友谊医院骨科，陕西 西安 710000；2.西电集团医院骨科，陕西 西安 710000

      卷次： 2020年31卷14期

      【摘要】 目的 观察创伤性胫骨平台骨折术后切口感染的病原学特征并分析影响感染的危险因素，为临床该类患者感染预防及控制提供依据。方法 回顾性分析2018年1月至2019年6月陕西省友谊医院282例创伤性胫骨平台骨折且行切开内固定术患者的临床资料，统计术后切开感染发生情况，对感染者切口分泌物或感染区软组织行细菌培养及药敏试验，并通过单因素分析、多因素Logistic回归分析筛选出影响患者术后切口感染的独立危险因素。结果 282例患者中术后切口感染 32例，占 11.35%；感染患者共检出病原菌 45株，其中革兰阳性菌 30株(66.67%)、革兰阴性菌14株(31.11%)，三种主要感染菌种分别为金黄色葡萄球菌、表皮葡萄球菌、大肠埃希菌，对青霉素耐药率最高，分别为93.75%、100.00%、85.71%，万古霉素耐药率最低，均为0；单因素分析结果显示，年龄、体质量指数、骨折类型、手术时长、合并糖尿病、合并骨筋膜室综合征、住院时间与创伤性胫骨平台骨折术后切口感染发生有关(P<0.05)；多因素Logistic回归分析结果显示，体质量指数≥24 kg/m2、开放性骨折、手术时长≥3 h、糖尿病、骨筋膜室综合征是创伤性胫骨平台骨折术后切口感染的独立危险因素(P<0.05)。结论 创伤性胫骨平台骨折术后存在一定切口感染率，且以革兰阳性菌感染为主，针对该类患者应尽可能缩短手术时长，积极预防骨筋膜室综合征、控制血糖，以预防感染发生。
      【关键词】 创伤性；胫骨平台骨折；术后切口感染；病原菌；影响因素
      【中图分类号】 R683.42 【文献标识码】 A 【文章编号】 1003—6350（2020）14—1811—04

Pathogenic bacteria distribution and influencing factors of postoperative incision infection of traumatic tibialplateau fractures.
WANG Bo 1, WANG Bin 2. 1.Department of Orthopedics, the Friendship Hospital of Shaanxi Province,Xi'an 710000, Shaanxi, CHINA; 2. Department of Orthopedics, the Hospital of Xidian Group, Xi'an 710000, Shaanxi,CHINA
【Abstract】 Objective To observe the etiological characteristics of postoperative incision infection of traumatictibial plateau fractures and analyze the risk factors of infection, so as to provide a basis for clinical prevention and con-trol of infection in such patients. Methods The clinical data of 282 patients with traumatic tibial plateau fractures whounderwent open internal fixation in the Friendship Hospital of Shaanxi Province from January 2018 to June 2019 wereretrospectively analyzed. The occurrence of postoperative incision infection was counted. Bacterial culture and drug sus-ceptibility test were performed on incision secretions or soft tissues in infected areas from infected persons, and univari-ate analysis and multivariate logistic regression analysis were used to screen the independent risk factors affecting post-operative incision infection in patients. Results Among the 282 patients, there were 32 cases with postoperative inci-sion infection, accounting for 11.35%. A total of 45 pathogenic bacteria strains were detected among infected patients, in-cluding 30 strains (66.67% ) of Gram-positive bacteria and 14 strains (31.11% ) of Gram-negative bacteria. The threemain infected bacteria strains were Staphylococcus aureus, Staphylococcus epidermidis and Escherichia coli, which had thehighest resistance rates to penicillin, with 93.75%, 100.00% and 85.71%, respectively, and the lowest resistance rates tovancomycin, with 0, 0, 0, respectively. Univariate analysis showed that age, body mass index, fracture type, operativetime, diabetes mellitus, osteofascial compartment syndrome, and hospital stay were associated with postoperative inci-sion infection of traumatic tibial plateau fractures (P<0.05). Multivariate logistic regression analysis showed that bodymass index ≥ 24 kg/m2, open fracture, operative time ≥ 3 h, diabetes mellitus, osteofascial compartment syndromeand hospital stay ≥ 14 d were independent risk factors for postoperative incision infection of traumatic tibial pla-teau fractures (P<0.05). Conclusion There is a certain incision infection rate after surgery of traumatic tibial plateaufractures, and Gram-positive bacterial infections are the main infections. For this type of patients, it is necessary to short-en the operative time as much as possible, actively prevent osteofascial compartment syndrome and control blood glu-cose so as to prevent the occurrence of infection.
      【Key words】 Traumatic; Tibial plateau fractures; Postoperative incision infection; Pathogenic bacteria; Influenc-ing factors