血清炎症因子对闭合性骨折内固定术后感染预测的研究

Prediction of infection following internal fixation of closed fractures by serum inflammatory factors

目的探讨血清炎症因子对闭合性骨折内固定术后感染的预测意义，以及指导手术时机和预防切口感染的意义。方法回顾性分析2014年1月至2016年7月采用内固定治疗的100例闭合性骨折患者资料，男52例，女48例；年龄24～76岁，平均45岁；骨折类型：股骨骨折14例，胫骨平台骨折19例，髌骨骨折25例，pilon骨折8例，胫腓骨中段骨折22例，跟骨骨折12例。其中21例患者术后出现切口感染。测定术前及术后感染指标C反应蛋白（CRP）、动态红细胞沉降率、降钙素原、白细胞。通过logistic回归分析研究感染指标与术后发生感染的相关性。选取有统计学意义的指标，制作ROC曲线，确定其最佳筛选点。结果所检测感染指标中，术前CRP测定和术后感染呈相关性，其他指标无明显相关性，术前1dCRP的最佳筛选点为25mg／L。结论术前CRP检测能够有效地预测术后感染的发生概率，若术前1dCRP〉25mg／L，则不适宜于第2天进行手术，且应在术后积极预防感染治疗。

Objective To explore the role of serum inflammatory factors in prediction of infection following internal fixation of closed fractures and its significance for surgical timing and infection prophylaxis. Methods A retrospective study was conducted of the 100 patients who had been treated by internal fixation for closed fracture from January 2014 through July 2016. They were 52 men and 48 women, aged from 24 to 76 years （average, 45 years）. There were 14 femoral fractures, 19 tibial plateau fractures, 25 patella fractures, 8 pilon fractures, 22 tibiofibular shaft fractures, and 12 ealcaneal fractures. Of them, 21 were inflicted by wound infection. The preoperative and postoperative infection indexes, CRP, ESR, PCT and leukocyte count, were recorded. Logistic regression analysis was conducted to test the correlation between the infection indexes and postoperative infection. The optimal cut-off value was determined by the receiver operating characteristic curve. Results CRP showed a significant correlation with postoperative infection while other indexes did not. The optimal cut-off value was 25 mg/L at one day before operation. Conclusions Preoperative determination of CRP may predict the risk of postoperative infection. CRP 〉 25 mg/L at one day before operation may indicate the following day is not suitable for surgery and active infection prophylaxis should be conducted after surgery.