胫骨平台骨折内固定术后引流量增多的危险因素分析

Risk Factors for Increasedpostoperative Drain Output Following Open Reduction and Internal Fixation of Tibial Plateau Fractures

目的探讨胫骨平台骨折内固定术后引流量增多的危险因素,为临床制定预防措施提供参考。方法回顾性分析2013年3月至2016年10月我院收治的253例胫骨平台骨折患者资料,其中男162例,女91例,年龄20~85岁,平均(49.25±12.96)岁。记录患者从术毕放置引流管至拔出为止的总引流量,定义引流量大于等于中位数为引流量增多。并分析其相关的危险因素,包括性别、年龄、身体质量指数(body mass index,BMI)、吸烟史、糖尿病史、高血压史、既往手术史、红细胞压积(hematocrit,HCT)、D-二聚体、受伤至手术时间、ASA麻醉分级、Schatzker分型、手术时间、切口数量、术中出血量、单/双侧钢板等。统计学方法先采用单因素分析,有显著意义的变量再纳入多因素Logistic回归分析。结果患者平均术后引流量为(262.19±185.47)mL,引流量增多127例,多因素Logistic回归分析显示吸烟史(OR=1.850,P=0.021)、Schatzker分型(OR=1.774,P=0.034)及手术持续时间延长(OR=2.003,P=0.007)是胫骨平台骨折内固定术后引流量增多的独立危险因素。结论胫骨平台骨折内固定术后引流量增多与吸烟史、Schatzker分型及手术时间密切相关,临床医生应制定有效措施预防术后引流量增多,以促进切口早期愈合,降低术后感染风险。

Objective To study the related risk factors for increased postoperative drainage following open reduction and internal fixation of tibial plateau fracturesso as to provide references for making precautionary measures.Methods 162 men and 91 women aged 20 to 85（mean 49.25±12.96）years old who had tibial plateau fractures from March 2013 to October 2016 were enrolled.Patients were divided into two groups based on normal or increased total drain output,with increased drain output defined as total drain output greater than or equal to the 50 th percentile.Variables analyzed included age,gender,BMI,smoking history,diabetes,history of hypertension,history of operation,HCT,D-dimer,duration from injury to operation,American Society of Anesthesiologists（ASA）class,Schatzker classification,operative time,number of incisions,intraoperative blood loss and unilateral/dual plate（s）.The multivariate Logistic regression model was used to analyze the risk factors.Results The average drain output was（262.19±185.47）mL,127 patients had increased drain output.Tobacco use（OR=1.850,P=0.021）,a Schatzker typeⅣ-Ⅵ（OR=1.774,P=0.034）and operative time（OR=2.003,P=0.007）were found to be independent risk factors for increased postoperative drain output.Conclusion Increased postoperative drain output of tibial plateau fractures is associated with smoking history,Schatzker classification and operative time.Preventive measures are suggested to promote wound healing.