下肢骨折固定术后感染的相关影响因素△

Factors related to infection after fixation of lower limb fractures

摘要:

[目的]分析影响下肢骨折固定术后感染（fracture-related infection, FRI）的相关因素。[方法]收集唐山市第二医院 2018 年 1 月—2022 年 1 月收治的 5 982 例下肢行骨折固定治疗的患者资料，将发生 FRI 的 83 例患者纳入感染组，按照组间骨折部位、骨折术式、性别、年龄匹配的方法选择未发生 FRI 的患者 166 例为无感染组，采用单因素分析和二元多因素逻辑回归分析下肢骨折固定术后 FRI 的危险因素。[结果]5 982 例行下肢骨折固定患者，术后 83 例患者发生 FRI，发生率为 1.4%。感染组的患者吸烟 [是/否, (36/47) vs (35/131), P＜0.001]、糖尿病 [是/否, (25/58) vs (21/145), P＜0.001]、开放性损伤 [是/否, (27/56) vs (18/148), P＜0.001] 、ASA 分级分级 [I/II/III, (17/35/31) vs (41/96/29), P=0.002]、BMI [(27.2±3.6) kg/m² vs (25.5±2.7) kg/m² ,P＜0.001]、 手术时间 [(180.0±48.0) min vs (138.5±44.6) min, P＜0.001]、术中出血量 [(351.6±101.5) ml vs (298.5±128.3) ml, P＜0.001] 均显著大于未感染组，但前者的术前 ALB 显著低于后者 [(34.4±2.4) g/L vs (37.2±4.0) g/L, P＜0.001]。多因素逻辑回归分析显示：开放性损伤 （OR=3.658, P=0.005）、吸烟史 （OR=2.436, P=0.014）、ASA 分级高 （OR=1.754, P=0.028）、BMI 高 （OR=1.190, P=0.003）、手术时间长 （OR=1.021, P＜0.001） 是下肢行固定术后发生 FRI 的独立危险因素。术前 ALB 高 （OR=0.803, P＜0.001） 为保护因素。 [结论] 有吸烟史、手术时间延长、高 BMI、高 ASA 分级、开放性损伤发生下肢 FRI 风险较高，临床应采取相应措施进行预防。

Abstract:

[Objective] To search the factors affecting fracture-related infection (FRI) after fixation of lower extremity fracture. [Methods] A total of 5 982 patients received surgical treatment for lower extremity fractures in Tangshan Second Hospital from January 2018 to January 2022. Of them, 83 patients proved FRI were fall into the FRI group, while other 166 patients without FRI were selected as the nonFRI group based on fracture site, fracture operation, gender and age matching. The risk factors related to FRI after lower limb fracture fixation were analyzed by univariate comparison and binary multifactor logistic regression. [Results] Of 5 982 patients who underwent surgical treatment for lower extremity fractures, 83 patients had FRI after operation, with the incidence of 1.4%. The FRI group proved significantly greater than the non-FRI group in terms of smoking [y/n, (36/47) vs (35/131), P＜0.001], diabetes [y/n, (25/58) vs (21/145), P＜0.001], open damage [yes/no, (27/56) vs (18/148), P＜0.001], ASA classification [I/II/III, (31/17/35) vs (29/41/96), P=0.002], BMI [(27.2±3.6) kg/m² vs (25.5±2.7) kg/m² , P＜0.001], operation time [(180.0±48.0) min vs (138.5±44.6) min, P＜0.001], intraoperative blood loss [(351.6±101.5) ml vs (298.5±128.3) ml, P＜0.001], whereas the former had significantly less preoperative ALB than the latter [(34.4±2.4) g/L vs (37.2±4.0) g/L, P＜ 0.001]. As consequences of multi-factor logistic regression, the open injury (OR=3.658, P=0.005), smoking history (OR=2.436, P=0.014), poor ASA grade (OR=1.754, P=0.028), high BMI (OR=1.190, P=0.003), and long operation time (OR=1.021, P＜0.001) were the independent risk factors for FRI after lower limb fracture fixation, while the high preoperative ALB (OR=0.803, P＜0.001) was a protective factor. [Conclusion] The patients with smoking history, prolonged operation time, high BMI, severe ASA grade, and open injury have higher risk of lower limb FRI, and corresponding clinical measures should be taken to prevent it.