髌骨骨折内固定手术术后感染的危险因素分析及预测模型建立

Analysis of Risk Factors and Establishment of Prediction Model for Infection After Internal Fixation of Patellar Fracture

目的探究髌骨骨折内固定手术术后感染的危险因素,并基于危险因素构建预测模型。方法选取2022年1月至2024年1月于徐州医科大学附属连云港医院接受髌骨骨折内固定手术的112例髌骨骨折患者为研究对象,根据术后是否发生感染,将患者分为感染组(n=17)和非感染组(n=95)。通过多因素Logistic回归分析,筛选出术后感染相关的独立危险因素;基于危险因素构建列线图预测模型,并使用受试者工作特征曲线(ROC)确定最优筛选点。结果两组患者年龄、是否有糖尿病史、术前软组织损伤程度、术中是否去除髌下脂肪垫、术后预防性应用抗生素、白细胞计数(WBC)、中性粒细胞与淋巴细胞比值(NLR)、C反应蛋白(CRP)、血沉(ESR)比较,差异均有统计学意义(P<0.05);多因素分析显示,术后是否预防性应用抗生素、年龄、NLR、CRP均为髌骨骨折内固定手术术后感染的独立危险因素(P<0.05);同时用列线图表示年龄、NLR、CRP、术后是否预防性应用抗生素,列线图模型的校准曲线预测值与实际值拟合良好。ROC曲线表明,术后是否预防性应用抗生素、年龄、NLR、CRP联合对髌骨骨折内固定手术术后感染的预测价值最高,其曲线下面积(AUC)为0.906,灵敏度为74.19%,特异度为95.00%。结论术后是否预防性应用抗生素、年龄、NLR、CRP均为髌骨骨折内固定手术术后感染的危险因素。基于危险因素构建的列线图预测模型具备较高的预测效能,以上指标联合可作为术后感染的有效预测指标。

Objective To investigate the risk factors for postoperative infection following internal fixation of patellar fractures and to develop a prediction model based on the risk factors.Methods A retrospective analysis was conducted on 112 patients who underwent internal fixation surgery for patellar fractures at the Affiliated Lianyungang Hospital of Xuzhou Medical University between January 2022 and January 2024.The patients were categorized into an infected group(n=17)and a non-infected group(n=95)based on the occurrence of postoperative infections.A multivariate Logistic regression analysis model was utilized to identify independent risk factors influencing postoperative infection,and a nomogram prediction model was constructed based on these factors.Receiver operating characteristic(ROC)curves were generated to determine optimal screening points for the identified risk factors.Results There were statistically significant differences in age,incidence of diabetes history,degree of soft tissue injury before surgery,removal of subpatellar fat pad during surgery,postoperative prophylaxis antibiotics,white blood cell count(WBC),neutrophil-lymphocyte ratio(NLR),C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)between the two groups(P<0.05).Taking the factors with differences in the results of univariate analysis as variables,multivariate analysis indicated that postoperative prophylactic antibiotic use or not,age,NLR and CRP were independent risk factors for infection after internal fixation surgery for patellar fracture(P<0.05).At the same time,age,NLR,CRP and whether antibiotics were used prophylactically after surgery were represented by a column graph.The predicted value of calibration curve of the column graph model fitted well with the actual value.Finally,ROC curve found that the combination of postoperative prophylactic antibiotic use or not,age,NLR and CRP had the highest predictive value on infection after internal fixation of patellar fracture,and the area under the curve was 0.906.Conclusion Postoperative prophylactic antibiotic use or not,age,NLR and CRP are risk factors for infection following internal fixation surgery for patellar fractures.The prediction model developed from this analysis demonstrates high predictive efficiency,and the combination of the above factors can be used as an effective indicator for predicting postoperative infection.