胫骨平台骨折切开复位内固定术后切口感染的发生率及危险因素分析

Wound infection after open reduction and internal fixation of tibial plateau fractures, a retrospective study regarding incidence and risk factors

目的探讨胫骨平台骨折切开复位内固定术后切口感染的发生率并分析其危险因素,供临床借鉴。方法对2015年1月至2018年1月我院收治的121例胫骨平台骨折并接受切开复位内固定手术的患者,根据有无切口感染,分为两组,采用病例对照研究方法,收集患者的一般资料、骨折特点、手术相关变量及生化指标等临床资料,采用单因素及多因素回归分析切口感染的危险因素。结果随访时间为1～3年,平均随访时间为16个月。共16例(13.2%)发生切口感染,其中表浅感染12例(9.9%),深部感染4例(3.3%)。最为常见的感染病原菌为金黄色葡萄球菌,其中部分为耐甲氧西林金黄色葡萄球菌。多因素回归分析显示高体质量指数(body mass index,BMI)、开放性骨折、手术时间延长以及ASA分级≥3级为胫骨平台切开复位内固定术后切口感染的危险因素。结论胫骨平台骨折切开复位内固定术后存在较高的切口感染发生率,高危危险因素包括高BMI、开放性骨折、手术时间延长以及ASA分级≥3级。术前充分评估患者的各项指标,采取相应措施以减少此类并发症的发生尤为重要。

Objective To determine the incidence and explore the associated risk factors of wound complications after open reduction and internal fixation(ORIF)of tibial plateau fractures(TPF).Methods From January 2015 to January 2018,121 patients who underwent ORIF for TPF in our hospital were retrospectively recruited.Based on wound infection or not,patients were divided into two groups.A case-control study was conducted.Patients’demographics,characteristics of fractures,operation related variables and laboratory indicators were collected.Wound complications associated risk factors were investigated by uni-variate analysis and following multi-variate analysis.Results Patients were followed 1 year to 3 years,a total of 16(13.2%)patients developed wound infections,of which 12(9.9%)were superficial infections and 4(3.3%)were deep infections.The most common causative agent was staphylococcus aureus,some of which were methicillin-resistant staphylococcus aureus(MRSA).Multivariate analysis indicated that the significant risk factors for wound infection occurrence were high BMI,open injury,prolonged operation time and American Society of Anesthesiologists(ASA)classes≥3 grade.Conclusions ORIF after TPF is associated with high incidence of wound infection.Risk factors included high BMI,open injury,prolonged operation time and ASA classes≥3 grade.Preoperative evaluations and preventions should be taken to decrease the incidence of wound infection after ORIF for TPF.