CAJ | 학술논문

目的：探讨胫骨骨折双钢板固定术后感染病原学特点以及感染危险因素，为临床治疗提供参考。方法回顾性分析2011年1月－2015年1月512例实施双钢板治疗的胫骨骨折患者临床资料，检测患者病原菌分布及耐药性，并对骨折类型、手术时间等因素实施单因素、多因素 logistic分析。结果512例患者中发生感染32例，感染率为6．25％；共分离出42株病原菌，其中革兰阳性菌25株占59．53％，以金黄色葡萄球菌和溶血葡萄球菌为主，革兰阴性菌17株占40．47％，以肺炎克雷伯菌、铜绿假单胞菌为主；金黄色葡萄球菌对万古霉素、利福平耐药率较低，其中对万古霉素无耐药性；单因素分析结果显示，年龄、骨折类型、侵入性操作、遗留死腔、基础疾病、抗菌药物联用、手术时间是感染的潜在危险因素（P＜0．05），多因素 logistic回归分析结果显示，开放性骨折、侵入性操作、高龄、遗留死腔是感染的独立危险因素。结论革兰阳性菌是胫骨骨折双钢板固定术后主要感染病原菌类型，开放性骨折、侵入性操作、高龄、遗留死腔是感染危险因素，应针对危险因素采取相应的预防措施，从而控制和降低感染的发生。
목적：탐토경골골절쌍강판고정술후감염병원학특점이급감염위험인소，위림상치료제공삼고。방법회고성분석2011년1월－2015년1월512례실시쌍강판치료적경골골절환자림상자료，검측환자병원균분포급내약성，병대골절류형、수술시간등인소실시단인소、다인소 logistic분석。결과512례환자중발생감염32례，감염솔위6．25％；공분리출42주병원균，기중혁란양성균25주점59．53％，이금황색포도구균화용혈포도구균위주，혁란음성균17주점40．47％，이폐염극뢰백균、동록가단포균위주；금황색포도구균대만고매소、리복평내약솔교저，기중대만고매소무내약성；단인소분석결과현시，년령、골절류형、침입성조작、유류사강、기출질병、항균약물련용、수술시간시감염적잠재위험인소（P＜0．05），다인소 logistic회귀분석결과현시，개방성골절、침입성조작、고령、유류사강시감염적독립위험인소。결론혁란양성균시경골골절쌍강판고정술후주요감염병원균류형，개방성골절、침입성조작、고령、유류사강시감염위험인소，응침대위험인소채취상응적예방조시，종이공제화강저감염적발생。
OBJECTIVE To explore the etiological characteristics of postoperative infections in the tibial fractures patients undergoing double‐plate fixation and analyze the risk factors for the infections so as to provide guidance for clinical treatment .METHODS The clinical data of 512 tibial fractures patients who underwent the double‐plate fixa‐tion from Jan 2011 to Jan 2015 were retrospectively analyzed ,then the distribution and drug resistance of the pathogens were observed ,and the univariate analysis and multivariate logistic analysis were performed to investi‐gate the related factors such as type of fracture and operation duration .RESULTS The infections occurred in 32 of 512 patients with the infection rate of 6 .25% .A total of 42 strains of pathogens have been isolated ,including 25 (59 .53% ) strains of gram‐positive bacteria and 17 (40 .47% ) strains of gram‐negative bacteria;the Staphylococ‐cus aureus and Staphylococcus haemolyticus were dominant among the gram‐positive bacteria ,and the K lebsiella pneumoniae and Pseudomonas aeruginosa were the predominant species of gram‐negative bacteria .The drug resist‐ance rates of the S .aureus to vancomycin and rifampicin were low ,and the drug resistance rate to vancomycin was 0 .The univariate analysis indicated that the potential risk factors for the infections included the age ,type of frac‐ture ,invasive operation ,remained dead space ,underlying disease ,combination use of antibiotics ,and operation duration (P<0 .05);the multivariate logistic regression analysis showed that the open fracture ,invasive opera‐tion ,advanced age ,and remained dead space were the independent risk factors for the infections .CONCLUSION The gram‐positive bacteria are the predominant pathogens causing the postoperative infections in the tibial fracture patients undergoing double‐plate fixation .The risk factors for the infections include the open fracture ,invasive op‐eration ,advanced age ,and remained dead space .It is necessary to take corresponding prevention measures aiming at the risk factors so as to control the infections .