老年患者胫骨平台骨折术后切口感染危险因素的Meta分析

Meta analysis of risk factors for postoperative incision infection in elderly patients with tibial plateau fracture

目的:通过Meta分析明确了胫骨平台骨折术后切口感染的危险因素,为临床早期预防和干预切口感染的发生提供依据。方法:计算机检索各数据库关于胫骨平台骨折术后切口感染危险因素的文献,应用RevMan 5.3软件对纳入文献进行Meta分析。结果:共纳入24篇文献,其中感染组592例,未感染组7519例。Meta分析结果显示:男性、年龄>60岁、身体质量指数(body mass index,BMI)、美国麻醉医师协会ASA分级(American society of anesthesiologists,ASA)≥3级、白蛋白<35 g/L、血红蛋白<正常范围下限、白蛋白/球蛋白<1.2、白细胞计数>10×10^(9)/L、中性粒细胞>6.3×10^(9)/L、淋巴细胞>3.2×10^(9)/L、吸烟史、糖尿病、骨筋膜综合征、多处创伤、开放性骨折、Schatzker分型(Ⅴ-Ⅵ)、术前住院时间>7 d、急诊、手术时间≥120 min、术中失血≥400 mL、双侧切口、2块钢板、外固定、侵入性操作、遗留死腔、住院时间为胫骨平台骨折术后切口感染的危险因素。结论:胫骨平台骨折术后切口感染的危险因素众多,但因各研究间样本量差异较大,部分文献存在方法质量学的不足,今后还需要更高质量的前瞻性研究予以验证。

Objective:To identify the risk factors of incision infection after tibial plateau fracture surgery by Meta-analysis,and to provide evidence for early prevention and intervention of incision infection.Methods:The literatures about risk factors of incision infection after tibial plateau fracture were searched by computer.Meta-analysis was performed by RevMan 5.3 software.Results:A total of 24 articles were included,including 592 cases of infection group and 7519 cases of non-infection group.The results of meta-analysis showed that male,age>60 years old,body mass index(BMI),American Society of Anesthesiologists(ASA)≥3,albumin<35 g/L,hemoglobin<lower limit of normal range,albumin/globulin<1.2,white blood cell count>10×10^(9)/L,neutrophil>6.3×10^(9)/L,lymphocytes>3.2×10^(9)/L,smoking history,diabetes,osteofascial syndrome,multiple traumas,open fractures,Schatzker classification(Ⅴ-Ⅵ),preoperative hospitalization time>7 days,emergency department,operation time≥120 min,intraoperative blood loss≥400 mL,bilateral incision,two plates,external fixation,invasive operation,residual cavity and hospitalization time were the risk factors for incision infection after tibial plateau fracture.Conclusion:There are many risk factors for postoperative incision infection after tibial plateau fractures,but due to the large difference in the sample size among studies and the deficiency of methodological quality in some literature,more high-quality prospective studies are needed to verify it in the future.