全膝关节置换术后切口并发症的危险因素分析

Risk factors for postoperative wound complications after total knee arthroplasty

目的回顾性研究全膝关节置换术(TKA)术后切口并发症的高危因素。方法 2014年10月至2017年9月在中山大学附属第一医院就诊,因符合膝关节骨关节炎及类风湿性骨关节炎诊断标准及手术适应证,行初次全膝关节置换术的患者共620人(738膝),其中55人(55膝)发生了术后切口并发症,分别采用两样本t检验、2检验及logistic回归分析回顾性分析病因、性别、年龄、高血压、糖尿病等相关临床因素,从中寻找导致TKA术后切口出现并发症的高危因素。结果术后切口并发症的发生率约7. 45%,经单因素分析及多因素logistic回归分析后,身体质量指数(BMI)过高、既往吸烟病史及术后使用抗凝药均是TKA术后发生切口并发症的重要危险因素,其比值比(OR)分别为1. 199、3. 119、2. 684(P <0. 05)。结论 BMI值过高、既往吸烟史及术后使用抗凝药均是TKA术后发生切口并发症的高危因素,术后应密切观察这些患者的切口情况。对于术后使用抗凝药物的患者,围手术期应注意评估药物预防静脉血栓栓塞症(VTE)、出血及发生切口并发症的风险,及时调整治疗方案。

Objective To analyze the clinical risk factor for postoperative wood complications following total knee arthroplasty(TKA)retrospectively.Methods From October 2014 to September 2017,620 cases(738 knees)underwent primary TKA because of the knee osteoarthritis or knee rheumatoid osteoarthritis in the First Affiliated Hospital of Sun Yat-sen University,among which 55 cases(55 knees)occurred postoperative wood complications.The possible risk factors such as etiology,gender,age,hypertension,diabetes were analyzed to determine the cause of postoperative wood complications with Two-sample t test,2 test and logistic regression analysis respectively.Results Postoperatively,55 cases(55 knees)had wood complications and the incidence rate is 7.45%.After univariate and multivariate logistic regression analysis,excessive body mass index(BMI),history of smoking and the use of anticoagulants were important risk factors for wood complications after TKA.The odds ratio(OR)were 1.199,3.119,2.684(P<0.05)respectively.Conclusions Patients with excessive BMI,history of smoking or using postoperative anticoagulant therapy are more likely to have wound complications after TKA.Close attention should be paid to the wound condition after the surgery,and evaluate the risk of anticoagulant therapy for the patients who need anticoagulant therapy to prevent VTE,bleeding and wound complications,and adjust the treatment in time.