踝关节骨折切开复位内固定术后手术部位感染的发生率及危险因素分析
《创伤外科杂志》[ISSN:/CN:]
- 期数:
- 2020年11期
- 页码:
- 851-855
- 栏目:
- 短篇论著
- 出版日期:
- 2020-11-17
文章信息/Info
- Title:
- Incidence and risk factors of surgical site infection after open reduction and internal fixation of ankle fracture
- 文章编号:
- 1009-4237(2020)11-0851-05
- Author(s):
- LU Xiao-yang; XI Wu
- Department of Orthopaedics,Huaian First People's Hospital,Huaian,Jiangsu 223300,China
- 分类号:
- R 683.42
- DOI:
- 10.3969/j.issn.1009-4237.2020.11.013
- 文献标识码:
- A
- 摘要:
- 目的 探讨踝关节骨折切开复位内固定(open reduction and internal fixation,ORIF)术后手术部位感染(surgical site infection,SSI)的发生率及危险因素。方法 回顾性分析2015年1月—2017年12月淮安市第一人民医院分院骨科接受ORIF治疗的踝关节骨折患者360例。男性208例,女性152例; 年龄32～72岁,平均50.7岁。根据患者术后是否发生SSI,将患者分为SSI发生组(28例)和SSI未发生组(332例)。记录SSI发生组患者感染情况及病原菌类型。比较两组患者在临床特征及实验室指标方面的差异,采用Logistic回归分析踝关节骨折ORIF术后SSI发生的危险因素。结果 360例患者中有28例发生SSI,感染率7.8%(95% CI:6.1%～9.3%)。其中,表浅切口感染20例(5.6%),深部切口感染8例(2.2%)。共检出病原菌32株,其中大肠埃希菌14株,金黄色葡萄球菌9株,表皮葡萄球菌5株,肺炎克雷伯菌3株,阴沟肠杆菌1株。两组患者在年龄、BMI、骨折类型(开放性骨折)、骨折至手术时间、住院天数、手术医师职称(住院医师及主治医师)、切口清洁度(Ⅱ～Ⅲ类手术切口)、手术时间、白细胞数异常、中性粒细胞百分比>75%、总蛋白、总蛋白异常、白蛋白、白蛋白异常、球蛋白、美国麻醉师学会(American Society of Anesthesiologists,ASA)分级(≥Ⅲ级)方面差异有统计学意义(χ2=2.342,P=0.021; χ2=2.811,P=0.012; χ2=11.322,P<0.001; t=3.891,P=0.001; t=6.222,P<0.001; χ2=7.533,P=0.011; χ2=5.351,P=0.021; t=3.473,P=0.001; χ2=6.134,P=0.013; χ2=6.241,P=0.012; t=3.157,P=0.003; χ2=4.211,P=0.042; t=2.822,P=0.008; χ2=4.001,P=0.041; t=2.773,P=0.009; χ2=4.751,P=0.035)。多因素Logistic回归分析显示,年龄、BMI、骨折类型(开放性骨折)、手术医师职称(住院医师及主治医师)、切口清洁度(Ⅱ～Ⅲ类手术切口)、中性粒细胞百分比>75%是影响踝关节骨折ORIF术后SSI发生的独立危险因素(P=0.032,0.011,0.001,0.022,0.023,0.013)。结论 年龄偏大、BMI偏高、开放性骨折、手术医师职称偏低、切口清洁度(Ⅱ～Ⅲ类手术切口)、中性粒细胞百分比>75%的踝关节骨折ORIF患者术后SSI发生风险较大。应针对相关危险因素采取积极的预防和控制措施,减少SSI的发生。
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备注/Memo
- 备注/Memo:
- 【通信作者】 席武,E-mail:2248814055@qq.com
