人工膝关节置换术后切口愈合不良的影响因素分析

Influencing factors for poor wound healing after total knee arthroplasty

目的观察人工膝关节置换术(total knee arthroplasty,TKA)后切口愈合情况,探讨影响切口愈合的因素。方法回顾性分析第三军医大学新桥医院2014年246例初次接受TKA患者的临床资料,对其一般资料(年龄、性别、体质量指数,术前情况如基础疾病、术前总蛋白、术前白蛋白、术前血红蛋白等)及术后指标(术后总蛋白、术后白蛋白、术后血红蛋白等)进行对比分析。采用SPSS 20.0统计软件进行单因素分析及多因素Logistic回归分析。结果发生愈合延迟等切口愈合不良情况的患者17例(6.91%),单因素分析显示,患者年龄、术前总蛋白及白蛋白、止血带压力、术后第1天总蛋白及白蛋白与切口愈合不良有关(P<0.05);Logistic回归分析结果显示,TKA患者术前白蛋白(OR=0.703,95%CI=0.552~0.895,P=0.004)、术后第1天白蛋白(OR=0.762,95%CI=0.623~0.933,P=0.008)为其保护因素,止血带压力(OR=2.695,95%CI=1.971~7.482,P=0.047)为其危险因素。结论影响TKA患者术后切口愈合的因素较多,应密切关注止血带压力和营养学指标(术前及术后白蛋白水平)。

Objective To observe the incision healing, in the patients after total knee arthroplasty （TKA） and analyze the influencing factors of poor wound healing. Methods Clinical data of 246 cases in primary surgery for TKA in Xinqiao Hospital from January to December 2014 were collected and retrospectively analyzed. Their general data （including age, sex, BMI, basic diseases, and the pre-operative levels of total protein, albumin and hemoglobin） and post-operative indicators （total protein, albumin and hemoglobin levels） were analyzed by univariate and multivariate logistic regression analyses for the potential risk factors of poor wound healing. Results There were 17 patients （6. 91% ） experiencing poor wound healing. Univariate analysis showed that significant differences were found in the following factors, age, pre-operative levels of total protein and albumin, pressure of tourniquet, and levels of total protein and albumin in the first day after surgery （P 〈 0. 05）. Logistics regression analysis showed prc-opcrative albumin （ OR = 0. 703, 95% CI=0.552 -0. 895, P =0.004） and albumin in the first day after surgery （OR =0. 762, 95% CI = 0. 623 - 0. 933, P = 0. 008 ） were the protective factors, while the pressure of tourniquet （ OR = 2. 695, 95% CI = 1. 971 - 7. 482, P = 0. 047） were risk factor for poor wound healing. Conclusion There are many factors influencing wound healing in TKA patients. Clinicians should pay more attention to the pressure of tourniquet and nutrient indexes （pre- and post-operative albumin）.