胫腓骨开放骨折术后术区感染的相关因素分析

Analysis of risk factors of the infection after operation of open tibiofibula fractures

目的 ：分析胫腓骨开放骨折术后术区感染的相关因素。方法 ：对2009年6月至2012年12月收治的胫腓骨开放骨折141例的临床资料进行回顾性分析,均为男性,年龄18~61岁,平均39.2岁,均为单侧。根据Gustilo分型,Ⅰ型5例,Ⅱ型44例,Ⅲa型27例,Ⅲb例56例,Ⅲc例9例。采集患者的年龄、性别、身体质量指数、基础疾病、手术时间、骨折部位、骨折分型、固定方式、术后引流、清创是否彻底等相关资料,对术后术区感染的发生情况进行统计,分析诸因素与术区感染发生之间的相关性。并将显著相关的变量引入多因素Logistic回归模型进行分析。结果：141例胫腓骨开放骨折术后术区感染病例22例,感染率15.6%。固定方式、清创是否彻底、基础疾病、术后引流与术后术区感染有明确相关性（P〈0.05）,相关程度依次升高,OR值分别为2.451、3.164、3.414、5.117。结论：术前积极治疗基础疾病、彻底清创、选择合适的固定方式及充分引流是预防术后术区感染的有力措施。

Objective：To analyze the related factors of the infection after operation of open tibiofibula fractures. Methods：The clinical data of 141 patients with open tibiofibula fractures underwent surgical treatment from June 2009 to December2012 were retrospectively analyzed. All the patients were male and aged from 18 to 61 years old with an average of 39.2 years;all the fractures were unilateral. According to Gustilo typing of fracure,5 cases were type Ⅰ,44 cases were type Ⅱ,27 cases were type Ⅲ a,56 cases were type Ⅲ b and 9 cases were type Ⅲ c. These clinical data included patients＇ age,gender,body mass index（BMI）,underlying diseases,time of operation,fracture site,fracture type,fixation method,postoperative drainage,debridement condition and so on. The postoperative infection conditions were recorded,and the correlation between above factors and infections were analyzed. Finally,the significant related variables were introduced into a Logistic regression model to evaluated their risk. Results：Among the 141 patients,22 cases developed with infection（15.6%）. The significant relative factors with infection contained fixation method,debridement condition,underlying diseases and postoperative drainage（P0.05）.The correlativities were stepped up in order,their odds ratios value was 2.451,3.164,3.414,5.117,respectively. Conclusion：Active treatment for underlying diseases before operation,thorough debridement for open wound,suitable fixation method for fracture and thorough draining are effective measures in preventing postoperative infection.