骨折术后手术部位感染的诊断及其治疗进展

A Review of the Diagnosis and Treatment Progress of Surgical Site Infection after Fracture Surgery

摘要: 近年来，随着社会经济的快速发展，外伤所致的开放性、多发性、复杂性骨折病例越来越多，而手术是其主要治疗手段，加之医疗技术的进步和各种新型内固定材料的不断涌现，骨折后接受内固定术的患者日益增多，术后手术部位感染(surgical site infection, SSI)的发生率越来越高。骨折术后感染是常见且严重的并发症，特别是对于开放性的骨折，因皮肤或黏膜破裂、缺损，导致正常的皮肤生理屏障作用消失，骨折断端外露污染，骨折部位软组织挫裂，血管床遭到破坏，周围组织愈合能力及抵抗感染能力减弱，同时术者对于损伤的判断，清创的彻底与否及固定方式的选择等等，都是其易发感染的潜在危险因素。一旦发生术后SSI，轻者导致伤口延迟愈合，重者可形成骨髓炎，甚至需要截肢，尤其对于有植入物的病例，往往导致灾难性后果，不仅会给患者带来肉体的痛苦和经济损失。因此，骨折术后并发感染的早期诊断和预后的判断成为创伤医学及骨科领域一个热点问题。现就四肢骨折术后感染早期诊断中的应用及诊断价值综述如下。

Abstract: In recent years, with the rapid development of society and economy, there have been more and more cases of open, multiple, and complex fractures caused by trauma, and surgery is the main treatment method. In addition, with the advancement of medical technology and the continuous emergence of various new internal fixation materials, the number of patients who undergo internal fixation surgery after fractures is increasing, and the incidence of surgical site infection (SSI) after surgery is increasing. Infection after fracture surgery is a common and serious complication, espe-cially for open fractures, where the normal skin physiological barrier function disappears due to skin or mucosal rupture or defect, the exposed end of the fracture is contaminated, the soft tissue at the fracture site is ruptured, the vascular bed is damaged, the healing ability and resistance to in-fection of the surrounding tissue are weakened. At the same time, the operator’s judgment of injury, thorough debridement, and selection of fixation methods are also important. They are all potential risk factors for their susceptibility to infection. In the event of postoperative SSI, the minor may lead to delayed wound healing, and the severe may lead to Osteomyelitis and even amputation. Espe-cially for cases with implants, it often leads to disastrous consequences, which will not only bring physical pain and economic losses to patients. Therefore, the early diagnosis and prognosis of post-operative infection after fracture surgery have become a hot topic in the fields of trauma medicine and orthopedics. The application and diagnostic value of early diagnosis of postoperative infection in limb fractures are summarized as follows.