35例胫腓骨骨折术后深部感染的原因及对策

目的 分析胫腓骨骨折术后深部感染的原因,探讨防治方法.方法 2003年1月～2007年1月,我们共收治胫腓骨骨折手术后深部感染35例.骨折类型:开放性骨折28例,闭合性骨折7例.骨折部位:胫骨上1/3骨折9例,中1/3骨折11例,下1/3骨折15例.分别采用钢板、交锁髓内钉、螺钉及钢丝.对胫腓骨骨折术后深部感染病灶行采用病灶扩创、负压引流或灌洗引流、及时拆除内固定、必要时更换为外固定、选择肌皮瓣覆盖创面等治疗,效果满意.结果 经采用病灶扩创、负压引流或灌洗引流、及时拆除内固定、必要时更换为外固定、选择肌皮瓣覆盖创面等治疗,深部感染均得到控制,平均时间26.5d.结论 胫腓骨骨折手术后深部感染原因是多方面的,宜积极预防,早期发现,及时采用病灶扩创、负压引流或灌洗引流、及时拆除内固定、必要时更换为外固定、选择肌皮瓣覆盖创面等治疗,畸形愈合、不愈合、功能障碍者留待后期治疗.

Analysis of postoperative deep wound infection after tibiofibula fracture in 35 cases

Objective To investigate the etiological factor of deep infection after tibiofibula fracture and surgical prevention and treatment techniques.Methods From June 2003 to June 2006,35 cases(28 OF and 7 CF) of postoperative deep wound infection received second debridements,negative pressure drainage/irrigation drainage,replacing internal fixation with external fixation and covering the raw surfaces with MCF.Among them,there were 9 cases of upper 1/3 fracture,11 cases of midst 1/3 fracture and 15 cases of inferior 1/3 fracture.Results All the cases were under control after the above treatments with mean healing time of 26.5d.Conclusion Since miscellaneous infectors can cause deep wound infection after tibiofibula fracture,the active prevention and early diagnosis is critical for the following treatments and the cases of malunion,disunion or functional impairment should be treated in later stage.