文献类型：期刊文献

中文题名：闭合性胫骨骨折内固定术后切口感染相关危险因素分析

英文题名：Analysis of risk factors related to postoperative incision infection for closed tibial fractures with internal fixation

作者：王斌[1];张文贤[2];廖敏捷[2];张堃[2];苏奇[3];李佳霖[3];严其凯[3];赵建伟[3]

第一作者：王斌

机构：[1]江西省玉山县黄家驷医院(玉山县人民医院)骨科,江西玉山334700;[2]甘肃省中医院创伤骨一科,甘肃兰州730050;[3]甘肃中医药大学研究生院,甘肃兰州730030

第一机构：江西省玉山县黄家驷医院(玉山县人民医院)骨科,江西玉山334700

年份：2021

卷号：18

期号：3

起止页码：79

中文期刊名：中国医药导报

外文期刊名：China Medical Herald

收录：CSTPCD

基金：甘肃省中医药管理局科研课题(GZK-2017-33)。

语种：中文

中文关键词：胫骨骨折;内固定;术后切口感染;危险因素

外文关键词：Tibial fracture;Internal fixation;Postoperative incision infection;Risk factors

摘要：目的分析探讨闭合性胫骨骨折术后切口感染的可能相关影响因素,为临床防治闭合性胫骨骨折术后切口感染提供一定的科学理论依据。方法通过医院电子病历系统回顾性地分析自2018年1月—2019年10月甘肃省中医院创伤骨科收治的经手术内固定治疗并获得随访的397例闭合性胫骨骨折患者资料。对患者资料进行单因素、多因素统计分析。结果397例患者进行随访6~12个月,其中发生术后切口感染患者10例。年龄≥60岁、住院天数≥2周、体重指数≥28 kg/m^(2)、合并基础疾病(糖尿病、高血压、高血脂)、吸烟、手术持续时间≥2 h、全身麻醉、术中失血量≥500 mL、未合理运用抗生素、未使用负压引流、软组织损伤分级越高的闭合性胫骨骨折术后切口感染率增高,差异均有统计学意义(均P<0.05)。其中年龄≥60岁(OR=4.136,95%CI:1.144~14.951,P<0.05)、肥胖(OR=4.949,95%CI:1.258~19.461,P<0.05)、合并糖尿病(OR=5.250,95%CI:1.449~19.027,P<0.05)、手术持续时间≥2 h(OR=5.714,95%CI:1.398~23.357,P<0.05)是术后切口感染的独立危险因素,而整个围术期合理运用抗菌药物(OR=0.128,95%CI:0.025~0.668,P<0.05)、使用负压引流(OR=0.184,95%CI:0.039~0.877,P<0.05)是术后切口感染的独立保护因素。结论术后切口感染与整个围术期诸多因素相关,临床工作中应足够重视,并针对性地采取积极的防治措施,以达到降低胫骨闭合性骨折术后切口感染率,最终达到实现健康医学的目标。
Objective To analyze and discuss the possible influencing factors of postoperative incision infection for closed tibial fracture,and to provide some scientific theoretical basis for clinical prevention and treatment of postoperative incision infection for closed tibial fracture.Methods The data of 397 patients with closed tibial fractures treated by surgical internal fixation and followed up in the Department of Orthopedics,Gansu Provincial Hospital of Traditional Chinese Medicine from January 2018 to October 2019 were retrospectively analyzed by using the hospital electronic medical record system.Single-factor and multi-factor statistical analysis were performed on patients’data.Results A total of 397 patients were followed up for six to twelve months,including ten patients with postoperative incision infection.Age≥60 years old,hospitalization days≥two weeks,body mass index≥28 kg/m^(2),combined with basic diseases(diabetes mellitus,hypertension,hyperlipidemia),smoking,duration of surgery≥two hours,general anesthesia,intraoperative blood loss≥500 mL,not reasonable use of antibiotics,not using negative pressure drainage,the higher soft tissue injury classification,the closed tibial fracture internal fixation of postoperative incision infection rate increased,the differences were statistically significant(all P<0.05).Among them,age≥60 years old(OR=4.136,95%CI:1.144-14.951,P<0.05),obesity(OR=4.949,95%CI:1.258-19.461,P<0.05),combined diabetes mellitus(OR=5.250,95%CI:1.449-19.027,P<0.05),duration of surgery≥two hours(OR=5.714,95%CI:1.398-23.357,P<0.05)were independent risk factors for postoperative incision infection,while rational use of antibiotics(OR=0.128,95%CI:0.025-0.668,P<0.05)and using negative pressure drainage(OR=0.184,95%CI:0.039-0.877,P<0.05)during the whole perioperative period were independent protective factors for postoperative incision infection.Conclusion Postoperative incision infection is related to many factors in the whole perioperative period.Enough attention should be paid to in clinical work and positive prevention measures should be taken accordingly to reduce the postoperative incision infection rate of closed tibial fracture and finally achieve the goal of health medicine.