桡骨远端关节内骨折术后发生切口感染的相关危险因素分析

Analysis of associated risk factors for surgical site infection after intra-articular fracture of distal radius by surgery

目的探究影响桡骨远端关节内骨折术后发生切口感染的相关危险因素,为预防此类并发症提供证据支持。方法回顾性分析手术治疗桡骨远端关节内骨折患者627例的临床资料,查阅电子病历系统、影像系统和检验报告,调取患者术周资料以及检验结果。根据美国疾病防治中心(Centers for Disease Control,CDC)定义感染标准确定是否发生切口感染。采用Logistics回归分析确定影响桡骨远端关节内骨折术后发生切口感染的危险因素。结果观察期内发生切口感染42例,切口感染发生率为6.7%。不同年龄、体重指数、吸烟状态、糖尿病、风湿免疫疾病、骨折AO分型、骨折类型、手术时机、美国麻醉协会(American Society of Anesthesiologists,ASA)分级、手术时间、术前血红蛋白水平以及白蛋白水平桡骨远端关节内骨折患者术后发生切口感染发生率差异有统计学意义(P<0.05或P<0.01)。多因素Logistics回归分析显示,吸烟、开放骨折GustiloⅡ~Ⅲ型、手术时间>130 min和术前白蛋白水平<35 g/L是桡骨远端关节内术后发生切口感染的影响因素。结论这些因素的探究对于评估罹患感染的风险具有重要意义,及时戒烟、合理规划手术流程以减少手术时间、并及时补充营养以减少切口感染风险。

Objective To investigate the risk factors for surgical site infection(SSI)after distal radius fracture,in order to provide evidence to prevent such type of complication.Methods Retrospective review of 627 cases of intraarticular fractures of distal radius surgically treated in department of hand surgery and orthopaedic trauma were performed.The perioperative data and biochemical test results were obtained by consulting the electronic medical record system,imaging system and test reports.Patients were divided into two groups according to criteria defined by the Centers for Disease Control(CDC)for infection:the infected group and the non-infected group.Univariate and multivariate logistic regression analyses were used to investigate the risk factors associated with the SSI.Results During the observational period,42 cases of SSIs were found,and the incidence was 6.7%.According to the results of univariate analysis,statistical difference was found between two groups(P<0.05 or P<0.01)in term of patient age,body mass index,smoking status,diabetes,rheumatic immune disease,AO type,fracture type(closed fractures and Gustilo classification),surgical timing,American Society of Anesthesiologists(ASA),operation time,preoperative hemoglobin and albumin level.Multivariate Logistics regression analysis showed that independent risk factors of postoperative SSI were:smoking,open fracture of GustiloⅡandⅢtype,operation time more than 130 minutes and lower preoperative albumin level(<35 g/L).Conclusion Identification of these factors is of great significance in assessing the risk of SSI.We suggest that patients should quit smoking in time,rationally plan the surgical procedure to reduce the operation time,and timely supplement nutrition to reduce the risk of SSI.