本文選題：脛骨開放性骨折 + Gustilo分型��； 參考：《河北醫(yī)科大學》2017年碩士論文

【摘要】：目的:隨著社會的不斷進步,高能量引起的開放性骨折的發(fā)病率也不斷上升。如果開放性骨折治療不當,則成為創(chuàng)傷領(lǐng)域中最棘手的疾病:骨髓炎、骨不連。國內(nèi)外學者對開放性骨折與感染率的相關(guān)性做了大量的臨床研究,如:開放性骨折的病因、分型、軟組織損傷程度、首次清創(chuàng)時間、清創(chuàng)方式、骨折的處理等方面,其中首次清創(chuàng)時間與感染率的關(guān)系一直是研究的焦點,在開放性骨折中,脛骨開放性骨折的發(fā)生率高,且具有較高的感染率,給患者、家人、社會帶來了沉重的負擔,本文旨在探討脛骨開放性骨折首次清創(chuàng)時間與感染率的相關(guān)性。方法:我們對河北醫(yī)科大學第三醫(yī)院創(chuàng)傷急救中心自2016年1月1日至2017年3月1日期間收治的脛骨開放性骨折患者進行前瞻性研究,排除標準:合并其他部分開放骨折;多發(fā)損傷(ISS評分大于16分);合并惡性腫瘤;合并骨關(guān)節(jié)畸形;伴有心、腦、肝、腎等慢性疾病;不能確定受傷到清創(chuàng)時間的。依據(jù)患者自受傷至進入手術(shù)室開始清創(chuàng)的時間,將患者分為A、B兩組,A組患者自受傷至進入手術(shù)室開始清創(chuàng)的時間為6小時內(nèi),B組為6小時外清創(chuàng),收集這些患者的性別、年齡、骨折類型(Gustilo分型)、受傷至進入手術(shù)室開始清創(chuàng)的時間、是否感染(傷口紅腫炎性滲出,則復查白細胞、C-反應蛋白、降鈣素原及血沉等,如升高,高度懷疑感染則進行分泌物培養(yǎng),若為陽性即定為感染,若為隱性即定為非感染)等資料。采用SPSS21.0進行統(tǒng)計學分析,比較兩組感染率有無統(tǒng)計學差異,來探討脛骨開放性骨折清創(chuàng)時間與感染率的相關(guān)性,計量資料符合正態(tài)分布且方差齊者用均數(shù)±標準差(X±s)表示,兩個獨立樣本用t檢驗進行比較;計數(shù)資料組用?2檢驗比較,若總例數(shù)少于40或某一格的期望值5則采用Fishers確切概率法,設(shè)定P0.05認為差異有統(tǒng)計學意義。結(jié)果:河北醫(yī)科大學第三醫(yī)院創(chuàng)傷急救中心自2016年1月1日至2017年3月1日期間共收治39例,43處脛骨開放性骨折的患者,車禍傷28例,墜落傷6例,擠壓傷1例,刀砍傷2例,其他6例,男性27、女性12人,最大82歲,最小10歲,平均年齡40.05±16.38歲,左側(cè)24例,右側(cè)19例;脛骨上、中、下段分別為4、12、27例,根據(jù)Gustilo分型:GustiloⅠ型、GustiloⅡ型、GustiloⅢA型、GustiloⅢB型、GustiloⅢC型分別為1例、18例、8例、10例、6例,有2例截肢的患者均屬于GustiloⅢC型,共15例發(fā)生感染,感染率為34.9%,細菌培養(yǎng)類型為金黃色葡萄球菌4例、鮑曼不動桿菌3例、肺炎克雷伯菌2例、溶血性葡萄球菌2例、凝固酶陰性葡萄球菌2例、大腸埃希菌1例、陰溝腸桿菌1例。A組年齡最大69歲,最小10歲,平均年齡41.00±17.27歲;B組年齡最大82歲,最小14歲,平均年齡39.48±16.13歲.兩組年齡差異無統(tǒng)計學意義(T=0.291,P0.05);根據(jù)Gustilo分型:A組GustiloⅠ型、GustiloⅡ型、GustiloⅢ型分別為1例、5例、10例,B組GustiloⅠ型、GustiloⅡ型、GustiloⅢ型分別為0例、13例、14例。兩組分型差異無統(tǒng)計學意義(Fisher=2.750,P0.05);A組共16例,6例感染,感染率為37.5%;B組共27例,有9例感染,感染率為33.3%,兩組感染率差異無統(tǒng)計學意義(?2=0.077,P0.05);GustiloⅡ型感染率為11.1%,GustiloⅢ型感染率為54.2%,GustiloⅡ/Ⅲ型比較,感染率差異有統(tǒng)計學意義(?2=8.305,P0.05)。結(jié)論:脛骨開放骨折清創(chuàng)時間大于6小時不增加感染率,脛骨開放性骨折損傷嚴重程度才是影響脛骨開放性骨折清創(chuàng)術(shù)后感染的重要因素。
[Abstract]:Objective: with the development of society, the high energy caused by open fracture incidence rate is also rising. If the improper treatment of open fracture, it is one of the most intractable diseases in the field of trauma: osteomyelitis, bone nonunion. Domestic and foreign scholars on the open fracture and infection rate of the related clinical research a large number of such as open fracture cause, type, degree of soft tissue injury, the first time of debridement, debridement, treatment and other aspects of fracture, of which the first debridement and the relationship between time and the infection rate has been the focus of research in open fractures, open fractures of the tibia with high incidence rate, and has a high infection rate for patients, family and society a heavy burden, this paper aims to explore the open tibial fracture first debridement time correlation with infection rate of trauma. Methods: we Hebei Medical University third hospital emergency center since 20 16 years from January 1st to March 1, 2017 open tibial fracture patients were prospectively studied. Exclusion criteria: combined with the other part of open fracture; multiple injury (ISS score more than 16 points); malignant tumor; bone and joint deformities; with the heart, brain, liver, kidney and other chronic diseases cannot be determined to clear the injured; a time. According to the patient from the injury to enter the operation room began debridement time, the patients were divided into A, B two groups, A group of patients from the injury to enter the operation room began debridement for 6 hours, B group for 6 hours outside the debridement, collect these patients gender, age, fracture type (Gustilo type), injury to enter the operation room began debridement time, whether infection (wound swelling inflammatory exudation, then review the white blood cells, C- reactive protein, procalcitonin and ESR, such as increased infection is highly suspected of secretion culture, if it is positive definite For infection, that is, if the recessive non infection). The information was statistically analyzed by SPSS21.0, compared with no significant difference between the two groups to discuss the infection rate, debridement of open fractures of the tibia and the infection rate of correlation time, measurement data with normal distribution and variance with mean standard deviation (X + s) said, compared with two independent samples t test; count data set with 2? Test comparison, if the total number of cases is less than 40 or a price expectations of 5 with Fishers's exact test, P0.05 considered statistically significant. Results: the Third Hospital of Hebei Medical University from January 1, 2016 to March 1, 2017 the trauma emergency center during a total of 39 patients treated, 43 patients with open tibial fracture, 28 cases of traffic accident injury, 6 cases of falling injury, crush injury in 1 cases, 2 cases of knifed injury, the other 6 patients, 27 male, 12 female, the oldest 82 years old, the youngest 10 years old, the average age of 40.05 + 1 6.38宀，

本文編號：1765185