锁定钢板治疗胫骨骨折术后感染的危险因素分析

Analysis of risk factors of postoperative infection of tibial fracture treated with locking plate

目的探讨锁定钢板治疗胫骨骨折术后感染的相关可能危险因素,为预防锁定钢板治疗胫骨骨折术后感染提供一定的理论依据。方法回顾性分析2017年12月—2019年1月甘肃省中医院骨科临床中心收治的经锁定钢板内固定治疗并获得随访的416例胫骨骨折患者资料。记录其感染的发生率,对患者资料进行分析,探究锁定钢板治疗胫骨骨折术后感染发生的原因及防治方法。结果416例患者随访6~12个月,其中发生感染患者45例,共分离出病原菌56株,其中革兰阳性菌株34例,占总病原菌的60.71%,主要以金黄色葡萄球菌和表皮葡萄球菌为主,革兰阴性球菌22株,占39.29%,以铜绿假单胞菌、大肠埃希菌为主。本研究单因素结果分析发现高龄(χ2=21.025,P<0.001)、体重指数(χ2=6.265,P=0.012)、合并糖尿病(χ2=65.590,P<0.001)、合并高血压病(χ2=24.547,P<0.001)、合并高血脂(χ2=40.045,P<0.001)、手术时间≥140 min(χ2=7.018,P=0.008)、术后用药时间(χ2=9.502,P=0.002)、住院时间≥15 d(χ2=9.890,P=0.002)、术中失血量(χ2=6.460,P=0.011)、骨折类型(χ2=17.104,P<0.001)、侵入性操作(χ2=5.657,P=0.017)是术后感染的潜在危险因素。单因素进行logistic回归分析认为体重指数≥30 kg/m2(P=0.006)、合并糖尿病(P<0.001)、住院时间≥15 d(P=0.002)、开放性骨折(P<0.001)、侵入性操作(P=0.020)是术后感染的独立危险因素。结论术后感染与患者自身情况、术中情况及术后均有相关性,围手术期应引起足够重视,并积极采取有效预防措施,制订精准的治疗方案,实行个体化治疗,降低术后的感染发生率。

Objective To explore the related risk factors of postoperative infection of tibial fracture treated by locking plate, and to provide a theoretical basis for the prevention of postoperative infection of tibial fracture treated by locking plate. Methods A total of 416 cases of tibial fracture treated by locking plate internal fixation and followed up in the Orthopaedic Clinical Center of Gansu Hospital of Traditional Chinese Medicine from December 2017 to January 2019 were analyzed retrospectively. The incidence of infection was recorded, and the data of patients were analyzed to explore the causes and prevention methods of infection after the treatment of tibial fracture with locking plate. Results A total of 416 patients were followed up for 6 to 12 months, 45 of them were infected, 56 strains of pathogens were isolated, 34 of which were gram-positive, accounting for 60.71% of the total distribution of pathogens, mainly Staphylococcus aureus and Staphylococcus epidermidis, 22 of which were gram-negative, accounting for 39.29%, mainly Pseudomonas aeruginosa and Escherichia coli. The results of single factor analysis showed that the elderly(χ~2=21.025, P < 0.001),body mass index(χ~2=6.265, P = 0.012), diabetes mellitus(χ~2=65.590, P < 0.001), hypertension(χ~2=24.547, P < 0.001),hyperlipidemia(χ~2=40.045, P < 0.001), operation time≥140 min(χ~2=7.018, P = 0.008), postoperative medication time(χ~2=9.502, P = 0.002), hospital stay ≥15 d(χ~2=9.890, P = 0.002), intraoperative blood loss(χ~2=6.460, P = 0.011), fracture types(χ~2=17.104, P < 0.001), invasive operation(χ~2=5.657, P = 0.017) were potential risk factors of postoperative infection. Logistic regression analysis showed that BMI≥30 kg/m2(P = 0.006), diabetes mellitus(P < 0.001), hospital stay ≥15 d(P = 0.002), open fracture(P < 0.001), invasive operation(P = 0.020) were independent risk factors for postoperative infection. Conclusion Postoperative infection is related to patients′ own condition, intraoperative condition and postoperative condition. Enough attention should be paid to it during perioperative period, and effective preventive measures should be taken actively, precise treatment plan should be made, individualized treatment should be carried out, and the incidence of postoperative infection should be reduced.