闭合性跟骨骨折手术部位感染的危险因素分析

Risk factors associated with surgical site infection in closed calcaneal fractures

目的探讨闭合性跟骨骨折术后手术部位感染的相关危险因素。方法回顾性分析2008年1月至2014年11月收治的312例闭合性跟骨骨折患者资料，男182例，女130例；年龄18～75岁，平均44．3岁；骨折按照Sanders分型：Ⅱ型52例，Ⅲ型146例，Ⅳ型114例；致伤原因：高处坠落伤159例，交通伤97例，重物砸伤56例。所有患者均采用外侧延伸“L”形切口行切开复位内固定术。性别、年龄、致伤原因、吸烟史、糖尿病、受伤至手术时间、手术时间以及骨移植纳入可能的危险因素，先采用单变量分析，差异有统计学意义的危险因素再采用多变量的logistic回归分析。结果根据患者切口有无感染分为感染组（28例，9．0％）和非感染组（284例，91．0％）。单变量分析显示感染组的吸烟率、手术时间明显高于非感染组，受伤至手术时间短于非感染组，差异有统计学意义（P〈0．05），而多变量分析显示仅手术时间与手术部位感染显著相关（P=0．005，OR=43．870）。结论手术时间是闭合性跟骨骨折手术部位感染的独立危险因素，保证手术质量的同时尽量缩短手术时间是预防手术部位感染的关键。

Objective To determine the risk factors associated with surgical site infection in closed calcaneal fractures. Methods A retrospective analysis was made on the clinical data of 312 patients with closed calcaneal fracture who had been treated by open plate osteosynthesis at our trauma centre from January 2008 to November 2014. They were 182 males and 130 females, from 18 to 75 years of age （average, 44.3 years） . By Sanders classification, 52 cases were type Ⅱ, 146 type Ⅲ, and 114 type Ⅳ. The fractures were caused by fall from a height in 159 cases, traffic accident in 97 ones, and crushing in 56 ones. All the patients received open reduction and internal fixation via a typical L-shaped lateral incision. Gender, age, cause for injury, smoking history, diabetes, interval between injury and operation, operation time and bone grafting were analyzed as possible risk factors in the study. Multivariate logistic regression was conducted for significant risk factors derived from the univariate analysis. Results The patients were divided into an infection group （28 cases, 9.0% ） and a non-infection group （284 cases, 91.0% ）. The univariate analysis showed that the rate of smoking was significantly higher, the operation time significantly longer, the interval between injury and opera- tion significantly shorter in the infection group than in the non-infection group （ P 〈 0. 05） . However, the lo- gistic regression analysis revealed that operation time was the only independent risk factor for surgical site in- fection （ P = 0. 005, OR = 43. 870）. Conclusion Since operation time may be an independent risk factor for surgical site infection in closed calcaneal fracture, it is important to speed up surgery as quick as possible in control of surgical site infection as long as the surgical quality is ensured.