类风湿足手术治疗后并发症的相关因素△

Factors related to complications after rheumatoid foot surgery

摘要:

[目的]探讨类风湿足患者手术治疗后并发症的相关危险因素。[方法]回顾性分析 2013 年 1 月—2024 年 9 月手术治疗类风湿足的 147 例患者的临床资料。统计术后并发症发生情况，采用单因素和二元多因素逻辑回归分析类风湿足术后并发症的危险因素。[结果] 147 例患者中，16 例 （10.9%） 出现并发症，其中切口愈合不良 8 例 （5.4%）、术后感染 4 例 （2.7%）、畸形复发 2 例（1.4%）、内固定失效 2 例（1.4%）；131 例（89.1%） 未出现并发症。单因素比较表明，并发症组以下指标显著高于非并发症组，包括年龄 [(68.6±7.4) 岁 vs (60.4±7.0) 岁, P=0.004]，BMI [(27.9±3.3) kg/m² vs (24.2±3.9) kg/m² , P= 0.018]、激素使用量 [少/中/多, (3/8/5) vs (96/22/13), P＜0.001] 和持续时间 [(121.5±14.6) 个月 vs (62.1±11.3) 个月, P＜0.001]、免疫抑制剂使用量 [少/中/多, (3/7/6) vs (89/26/16), P＜0.001] 和持续时间 [(116.2±10.5) 个月 vs (70.3±13.8) 个月, P＜0.001]、吸烟 [是/否, (11/ 5) vs (39/92), P=0.021]、糖尿病 [是/否, (14/2) vs (23/108), P＜0.001] 及手术时间 [(167.4±8.3) min vs (143.7±20.2) min, P=0.003]。多因素分析显示，年龄 （OR=2.413, 95%CI: 1.345~4.578, P=0.021）、糖尿病史（OR=2.983, 95%CI: 1.005~8.345, P=0.004）、激素和免疫抑制剂的使用 （OR=3.278, 95%CI: 1.003~9.796, P＜0.001） 是术后并发症发生的独立危险因素。[结论] 年龄偏大、有糖尿病史、激素和免疫抑制剂使用史的类风湿足患者发生术后并发症的风险较大，临床中应加强围术期管理，降低并发症发生率。

Abstract:

[Objective] To search the risk factors of postoperative complications in rheumatoid foot. [Methods] A retrospective study was conducted on 147 patients who had rheumatoid foot treated surgically from January 2013 to September 2024. The incidence of postoperative complications was statistically analyzed. Univariate comparison and binary logistic regression were used to search the factors related to postoperative complications of rheumatoid foot. [Results] Among the 147 patients, 16 patients (10.9%) had complications, including 8 with poor incision healing (5.4%), 4 with postoperative infection (2.7%), 2 with deformity recurrence (1.4%), and 2 with internal fixation failure (1.4%), while the remaining 131 patients (89.1%) had no complications. Regarding univariate comparison, the complication group was significantly higher than the non-complication group in the following items, including age [(68.6±7.4) years vs (60.4±7.0) years, P=0.004]. BMI [(27.9±3.3) kg/m² vs (24.2±3.9) kg/m² , P=0.018], cortical steroid use dosage [low/medium/high, (3/8/5) vs (13/96/22), P＜0.001] and duration [(121.5±14.6) months vs (62.1±11.3) months, P＜0.001], immunosuppressant use dosage [low/medium/high, (3/7/6) vs (16/89/26), P＜ 0.001] and the duration [(116.2±10.5) months vs (70.3±13.8) months, P＜0.001], smoking [yes/no, (11/5) vs (39/92), P=0.021], diabetes [yes/ no, (14/2) vs (23/108), P＜0.001], and operation time [(167.4±8.3) min vs (143.7±20.2) min, P=0.003]. As results of binary logistic regression, the age (OR=2.413, 95%CI: 1.345~4.578, P=0.021), diabetes (OR=2.983, 95%CI: 1.005~8.345, P=0.004), cortical steroid and immunosuppressant use (OR=3.278, 95%CI: 1.003~9.796, P＜0.001) were the independent risk factor for postoperative complications of rheumatoid foot. [Conclusion] The patients with advanced age, diabetes, cortical steroid and immunosuppressant useage are at higher risk of postoperative complications in rheumatoid foot , and perioperative management should be strengthened in clinical practice to reduce the incidence of complications.