儿童人类咬伤伤口的处理：一项9年回顾性研究
Management of Human Bite Wounds in Children: A 9-Year Retrospective Study.
作者信息
Ao Wei, Ma Wei, Zhang Run, Xiang Li, Zhang Xue-Bing, Liu Jun-Hong
机构信息
Department of Day Surgery Ward Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
Department of Day Surgery Ward Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China; Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Chongqing, China.
出版信息
J Surg Res. 2025 Aug;312:25-30. doi: 10.1016/j.jss.2025.05.007. Epub 2025 Jun 10.
INTRODUCTION
Human bites are one of the common traumas among children; however, their treatment remains controversial. This study aimed to explore the treatment of human bite wounds in children.
MATERIALS AND METHODS
The clinical data of 792 children with human bites were collected between 2014 and 2022. Based on their treatment methods, the patients were divided into the debridement group, primary closure group, and delayed closure group, and the therapeutic effects were analyzed. Pearson χ 2 test was employed to compare classified variables. We used binary logistic regression to identify the risk factors of wound infection.
RESULTS
In total, 660 children with human bites meeting the inclusion and exclusion criteria were enrolled in this study, with an average age of 8.38 y (2 mo to 17 y). The participants were mainly male (85.2%), and the most common site of injury was the head or neck (81.4%). In total, 111 children (16.8%) developed wound infection, and the infection rate was significantly lower in the delayed closure group than in the primary closure group (12.6% versus 29.0%, P < 0.001), but there was no significant difference between the delayed closure group and the debridement group (12.6% versus 7.6%, P = 0.139). There were 395 children with optimal wound healing. The optimal wound healing rate in the delayed closure group was significantly higher than that in the debridement group (76.4% versus 33.1%, P = 0.733), with no significant difference between the delayed closure group and the primary closure group (76.4% vs 80.8%, P < 0.001). In multivariate logistic regression analysis, advanced age (risk ratio (RR) 1.195 per increasing 1-y interval, 95% confidence interval [CI] 1.090-1.310), suture method (RR 4.375 for primary closure compared to delayed closure, 95% CI 2.173-8.808), and onset-to-treatment time (RR 1.029 for each additional hour, 95% CI 1.010-1.049) were independent predictors of wound infection.
CONCLUSIONS
For human bites of children, we recommend delayed closure, which can achieve both a low wound infection rate and satisfactory wound healing.
引言
人类咬伤是儿童常见的创伤之一；然而，其治疗方法仍存在争议。本研究旨在探讨儿童人类咬伤伤口的治疗方法。
材料与方法
收集2014年至2022年间792例儿童人类咬伤的临床资料。根据治疗方法，将患者分为清创组、一期缝合组和延期缝合组，并分析治疗效果。采用Pearson χ2检验比较分类变量。我们使用二元逻辑回归分析来确定伤口感染的危险因素。
结果
本研究共纳入660例符合纳入和排除标准的儿童人类咬伤患者，平均年龄8.38岁（2个月至17岁）。参与者以男性为主（85.2%），最常见的受伤部位是头部或颈部（81.4%）。共有111例儿童（16.8%）发生伤口感染，延期缝合组的感染率显著低于一期缝合组（12.6%对29.0%，P<0.001），但延期缝合组与清创组之间无显著差异（12.6%对7.6%，P=0.139）。有395例儿童伤口愈合良好。延期缝合组的伤口愈合优良率显著高于清创组（76.4%对33.1%，P=0.733），延期缝合组与一期缝合组之间无显著差异（76.4%对80.8%，P<0.001）。在多因素逻辑回归分析中，年龄增长（每增加1岁风险比[RR]1.195，95%置信区间[CI]1.090-1.310）、缝合方法（一期缝合与延期缝合相比RR 4.375，95%CI 2.173-8.808）以及受伤至治疗时间（每增加1小时RR 1.029，95%CI 1.010-1.049）是伤口感染的独立预测因素。
结论
对于儿童人类咬伤，我们建议采用延期缝合，其可实现较低的伤口感染率和满意的伤口愈合效果。
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