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中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (03) : 309 -314. doi: 10.3877/cma.j.issn.1674-134X.2022.03.008

临床论著

Pilon骨折术后发生手术部位感染的危险因素分析
毛文文1, 陈昊2, 李立3, 朱友森3, 张敏3, 陈刚3,†()   
  1. 1. 225100　扬州大学医学院；225200　扬州市江都人民医院
    2. 225100　扬州大学医学院
    3. 225200　扬州市江都人民医院
  • 收稿日期:2021-04-05 出版日期:2022-06-01
  • 通信作者: 陈刚
  • 基金资助:
    扬州市科技局重点项目(SSF2021000051)

Risk factors of surgical site infection following surgical treatment of Pilon fractures

Wenwen Mao1, Hao Chen2, Li Li3, Yousen Zhu3, Min Zhang3, Gang Chen3,†()   

  1. 1. Medical College of Yangzhou University, Yangzhou 225100, China; Department of orthopedics, Yangzhou Jiangdu people's Hospital, Yangzhou 225200, China
    2. Medical College of Yangzhou University, Yangzhou 225100, China
    3. Department of orthopedics, Yangzhou Jiangdu people's Hospital, Yangzhou 225200, China
  • Received:2021-04-05 Published:2022-06-01
  • Corresponding author: Gang Chen
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毛文文, 陈昊, 李立, 朱友森, 张敏, 陈刚. Pilon骨折术后发生手术部位感染的危险因素分析[J]. 中华关节外科杂志(电子版), 2022, 16(03): 309-314.

Wenwen Mao, Hao Chen, Li Li, Yousen Zhu, Min Zhang, Gang Chen. Risk factors of surgical site infection following surgical treatment of Pilon fractures[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(03): 309-314.

目的

探讨Pilon骨折术后发生手术部位感染的相关危险因素。

方法

回顾性分析2015年1月至2020年6月行因Pilon骨折在扬州市江都人民医院行手术治疗的309例患者的临床资料，排除入院前有感染病史的患者，根据术后是否发生手术部位感染分为两组。比较两组患者之间性别、年龄、身体质量指数(BMI)、吸烟史、高血压、糖尿病病史、骨折类型、有无张力性水泡、是否合并关节脱位、骨折分型、受伤至手术时间、术后引流量、手术时间、手术入路、美国麻醉医师协会麻醉分级(ASA)、内固定钢板数量、是否临时使用外固定支架等相关因素对手术部位可能发生感染的影响。统计学分析包括独立样本t检验、卡方检验或Fisher精确检验，将有统计学意义的单因素为自变量行多因素logistic回归分析。

结果

本研究共纳入研究对象309例，其中术后发生手术部位感染25例，感染发生率为8.1%(25/309)，22例患者切口分泌物培养阳性结果，阳性率为88%，最常见病原体是金黄色葡萄球菌(7/22, 31.8%)，大肠埃希菌(6/22, 27.3%)和表皮葡萄球菌(4/22, 18.2%)。单因素分析显示两组患者手术时间、高血压、国际内固定学会骨折分类系统(AO)分型、开放性骨折、吸烟史的差异有统计学意义(t＝2.629，χ2＝7.646、12.184、6.438、14.268，均为P<0.05)。而多因素logistic回归分析显示开放性骨折、吸烟为Pilon骨折术后感染的独立危险因素[比值比(OR)＝3.770、11.129，均为P<0.05]。

结论

开放性骨折、吸烟是Pilon骨折切开复位内固定术后手术部位感染的独立危险因素。

关键词: 踝骨折, 骨折切开复位, 骨折固定术，内, 外科伤口感染, 危险因素
Objective

To investigate the risk factors of surgical site infection after Pilon fracture surgery.

Methods

The clinical data of 309 patients who underwent surgical treatment for Pilon fracture in Yangzhou Jiangdu People′s Hospital from January 2015 to June 2020 were analyzed retrospectively, excluding patients with a history of infection before admission. They were divided into two groups according to whether postoperative surgical site infection occurred. The gender, age, body mass index (BMI), smoking history, hypertension, diabetes history, fracture type, tension blister, joint dislocation, fracture classification, injury to operation time, postoperative drainage, operative time, surgical approach, anesthesiologist's anesthesia level (ASA), number of internal fixation plates, and whether used external fixing bracket temporarily in the two groups were compared. Statistical analysis included independent sample t test, chi square test or Fisher exact test. The statistically significant single factors were taken as independent variable for logistic regression analysis.

Results

A total of 309 patients were included in this retrospective study, including 25 cases of postoperative infection at the surgical site, with an infection rate of 8.1% (25/309). Twenty-two patients had positive results of incision secretion culture, with a positive rate of 88%. The most common pathogens were Staphylococcus aureus (7/22, 31.8%), Escherichia coli (6/22, 27.3%) and Staphylococcus epidermidis (4/22, 18.2%). Univariate analysis showed that there were significant differences in operation time, hypertension, Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, open fracture and smoking history between the two groups (t=2.629, χ2=7.646, 12.184, 6.438, 14.268, all P<0.05). Multivariate logistic regression analysis showed that open fracture and smoking were independent risk factors for postoperative infection of Pilon fracture [odds ratio (OR)=3.770, 11.129, both P <0.05].

Conclusion

Open fracture and smoking are independent risk factors of surgical site infection after open reduction and internal fixation of Pilon fracture.

Key words: Ankle fractures, Fracture open reduction, Internal fracture fixation, Surgical site infection, Risk factors
表1 两组计量资料的比较(±s )
分组 例数 年龄(岁) 受伤至手术时间(d) 手术时间(min) 术后引流量(ml) BMI(kg/m2)
感染组 25 47±9 13.6±4.9 120±51 85±31 26±3
未感染组 309 46±14 12.5±6.8 103±30 87±34 25±3
t值   0.397 0.725 2.629 0.285 1.139
P值   >0.05 >0.05 0.009 >0.05 >0.05
表2 两组计数资料的比较(例)
影响因素   感染组 未感染组 χ2值 P值
例数   25 284    
性别 男 12 158 0.541 >0.05
女 13 126
高血压 有 13 74 7.646 0.006
无 12 210
糖尿病 有 7 116 1.582 >0.05
无 18 168
吸烟史 有 19 106 14.268 0.001
无 6 178
开放性骨折 是 15 98 6.438 0.011
否 10 186
AO分型 A型 1 84 12.184 0.002
B型 6 92
C型 18 110
ASA分级 Ⅰ、Ⅱ 14 182 0.647 >0.05
Ⅲ、Ⅳ 11 102
张力性水泡 有 23 228 1.372 >0.05
无 2 56
合并脱位 有 9 69 1.668 >0.05
无 16 215
钢板数量 ≤2 13 197 3.183 >0.05
>2 12 87
临时使用外固定支架 有 6 58 0.179 >0.05
无 19 226
手术入路 内侧 10 156 6.173 >0.05
前外侧 5 71
前内侧 5 30
后外侧 4 21
后内侧 1 6
表3 Pilon骨折术后感染多因素分析结果
影响因素 B值 SE Wald值 P值 OR 95%CI
吸烟史(有) 1.327 0.655 4.109 0.043 3.770 (1.045，13.600)
开放性骨折(有) 2.410 0.658 10.112 0.001 11.129 (2.520, 49.138)
手术时间 0.017 0.009 3.272 0.070 1.017 (0.999, 1.036)
高血压(有) 0.178 0.581 0.094 0.759 1.195 (0.383, 3. 734)
AO分型(C型) 0.554 0.586 0.893 0.345 1.739 (0.552, 5.485)
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