上肢单纯闭合性骨折围术期抗生素应用对切口愈合的影响

摘要

Objective To respectively investigate the impact of perioperative use of antibiotics on incision healing of simple upper limb closed fracture.Methods The study enrolled 124 patients with simple upper limb closed fracture treated from October 2012 to June 2013,including fracture of humerus (surgical neck,shaft,and supracondyla),fracture of forearm (ulna,olecranon,and radius)and fracture of metacarpus.The patients were allocated to non-antibiotic group (n =73) and antibiotictreated group (n =51) according to the random number table.Between-group analysis was made on body temperature,peripheral white blood cell count,C-reactive protein level,drainage fluid culture and incision healing.Results Sex,age,disease entity and operation time were similar between the two groups (P ＞ 0.05).Non-antibiotic and antibiotic-treated groups showed no significant differences in body temperature [preoperation:(36.50 ± 0.27) ℃ vs (36.70 ± 0.39) ℃ ; postoperation:(37.64 ± 0.37) ℃vs (37.41 ±0.41)℃],peripheral white blood cell count [preoperation:(6.1 ±1.0) × 109 mol/L vs (6.5 ±0.8) × 109 mol/L; postoperation:(12.1 ±0.7) × 109 mol/L vs (11.3 ±0.6) × 109mol/L] and C-reactive protein level [preoperation:(7.2 ±0.9)mg/L vs (6.7 ±0.7)mg/L; postoperation:(12.0 ± 1.3) mg/L vs (13.4 ±0.9)mg/L] (P ＞0.05).Incisional infection occurred in 1 case (1％) in non-antibiotic group,but none in antibiotic-treated group (P ＞ 0.05).Conclusions For simple upper limb closed fracture,perioperative use of antibiotic has advantages of slight trauma,short operation time and few bleeding.Likewise,satisfactory bone healing is achieved in the absence of antibiotics during perioperative period.%目的 前瞻性对比观察围术期抗生素使用与否对上肢单纯闭合性骨折术后切口愈合的影响.方法 选择2012年10月-2013年6月收治的124例上肢单纯闭合性骨折患者,包括肱骨骨折(肱骨外科颈骨折、肱骨于骨折、肱骨髁上骨折)和前臂骨折(尺骨骨折、尺骨鹰嘴骨折、桡骨骨折)及掌骨骨折等.按随机数字表法分为非抗生素组(围术期均未使用抗生素,73例)和抗生素组(围术期不同程度使用抗生素,51例),对两组患者术前及术后体温、外周血白细胞计数、C反应蛋白的变化、引流液细菌培养及术后切口愈合状况进行比较分析.结果 两组患者性别、年龄、疾病种类及手术时间差异均无统计学意义(P＞0.05).非抗生素组和抗生素组术前与术后体温[(36.50±0.27)℃、(36.70 ±0.39)℃]、[(37.64±0.37)℃、(37.41±0.41)℃]、外周血白细胞计数[(6.1 ±1.0)×109mol/L、(6.5±0.8)×109mol/L]、[(12.1±0.7)×109mol/L、(11.3±0.6)×109mol/L]与C反应蛋白[(7.2±0.9)mg/L、(6.7 ±0.7) mg/L]、[(12.0±1.3) mg/L、(13.4±0.9) mg/L]的变化差异均无统计学意义(P＞0.05).非抗生素组术后切口感染1例,感染发生率为1％;抗生素组术后切口全部愈合,无感染,两组感染发生率差异无统计学意义.结论 上肢单纯闭合性骨折围术期不使用抗生素切口也能达到理想骨折愈合.