踝关节骨折患者切开复位内固定术后发生感染的危险因素分析

Risk factors for infection after open reduction and internal fixation in patients with ankle fractures

目的探讨踝关节骨折患者切开复位内固定术后发生感染的危险因素,为临床预防措施的制定提供参考。方法本研究为前瞻性研究,抽取2019年1月至2022年1月郑州大学附属郑州中心医院收治的踝关节骨折患者362例,均行切开复位内固定术治疗,术后2周通过电话或网络联系方式提醒患者入院复诊,评估患者术后感染的发生情况,将患者分为感染组和未感染组。记录并比较两组患者的一般资料及实验室指标,经单因素、Logistic回归分析找出踝关节骨折患者切开复位内固定术后感染发生的危险因素。结果362例踝关节骨折患者中失访12例,最终纳入350例。术后2周,350例踝关节骨折患者中发生感染22例(6.29%),未发生感染328例(93.71%)。两组患者性别、年龄、职业、合并高血压等方面比较,差异未见统计学意义(P>0.05);感染组术前体质指数≥28 kg/m^(2)、合并糖尿病、高能量损伤者占比高于未感染组,手术时间长于未感染组,差异有统计学意义(P<0.05)。Logistic回归分析结果显示,术前体质指数≥28 kg/m^(2)、合并糖尿病、高能量损伤、手术时间长是踝关节骨折患者切开复位内固定术后发生感染的危险因素(OR>1,P<0.05)。结论踝关节骨折患者切开复位内固定术后发生感染的危险因素为术前体质指数≥28 kg/m^(2)、合并糖尿病、高能量损伤、手术时间长,针对上述因素开展术后感染管理,可以预防术后感染的发生。

Objective To investigate the risk factors for infection after open reduction and internal fixation in patients with ankle fractures,and to provide reference for the formulation of clinical preventive measures.Methods This was a prospective study.A total of 362 patients with ankle fractures admitted to Zhengzhou Central Hospital Affiliated to Zhengzhou University from January 2019 to January 2022 were selected,and they were treated by open reduction and internal fixation.Two weeks after the operation,the patients were reminded to be admitted to the hospital for follow-up visits by telephone or online contact.And the occurrence of postoperative infection was evaluated,and the patients were divided into infection group and non-infection group.The general information and laboratory indicators of the two groups were recorded and compared.The risk factors for infection after open reduction and internal fixation in patients with ankle fractures were identified by single factor and Logistic regression analysis.Results Of the 362 patients with ankle fractures,12 cases were lost to follow-up,and 350 patients were finally included.Two weeks after operation,infection occurred in 22 cases(6.29%)among the 350 patients with ankle fractures,and 328 cases(93.71%)did not.There was no significant difference in gender,age,occupation,and hypertension between the two groups(P>0.05).The proportion of preoperative body mass index≥28 kg/m^(2),diabetes mellitus,and high-energy injury in the infection group were higher than those in the non-infection group,however,the operation time of the infection group was longer than that of the non-infection group,and the differences were statistically significant(P<0.05).Results of Logistic regression analysis showed that preoperative body mass index≥28 kg/m^(2),diabetes mellitus,high-energy injury,and long operation time were the risk factors for infection after open reduction and internal fixation in patients with ankle fractures(OR>1,P<0.05).Conclusions The risk factors for infection after open reduction and internal fixation in patients with ankle fractures includes preoperative body mass index≥28 kg/m^(2),diabetes mellitus,high-energy injury,and long operation time.Postoperative infection management should be carried out according to the above factors to prevent postoperative infection.