闭合性踝关节骨折术后发生手术部位感染的危险因素分析

背景:踝关节骨折是临床常见骨折,关于闭合性踝关节骨折术后切口感染的研究相对较少,如何降低术后感染率和切口不愈合风险是手术治疗成功的关键。目的:分析闭合性踝关节骨折患者内固定术后发生手术部位感染(SSI)的危险因素,为临床制订预防控制措施提供参考。方法:回顾性分析2015年5月至2018年5月行手术治疗的206例闭合性踝关节骨折患者,男130例,女76例,年龄21~87岁,平均(48.1±17.5)岁。术后3个月内发生浅表或深部感染的19例为感染组,其余187例为非感染组。对感染组患者的病原菌类型进行分析。记录所有患者发生SSI的潜在危险因素:①患者相关:性别、年龄、体重指数(BMI)、吸烟史、高血压病及糖尿病等合并症;②创伤相关:损伤机制、骨折分型、软组织损伤程度、有无张力性水泡及是否合并脱位等;③手术相关:受伤至手术时间、美国麻醉医师协会(ASA)麻醉分级、手术时间、内置物类型、术中出血量、缝合方法及术后石膏固定等。采用单因素分析和多因素Logistic回归分析发生SSI的影响因素。结果:SSI发生率为9.2%(19/206),感染组细菌培养阳性率为94.7%(18/19),吸烟史(P=0.034)、手术时间延长(P=0.046)和术后未行石膏固定(P=0.021)是闭合性踝关节骨折术后发生SSI的独立危险因素。结论:对于闭合性踝关节骨折患者,劝告患者术前术后戒烟、有效缩短手术时间、术后早期阶段石膏固定或有利于减少SSI的发生。

Risk factors for surgical site infection following surgery of closed ankle fractures

Background:Ankle fractures are common in clinic.There are relatively few studies on postoperative wound infec?tions of closed ankle fractures.How to reduce the postoperative infection rate and the risk of incision nonunion is very impor?tant for the success of operation.Objective:To analyze the risk factors for surgical site infection(SSI)following open reduction and internal fixation(ORIF)of closed ankle fractures in order to provide references for making precautionary measures.Meth?ods:Data of 206 patients with closed ankle fractures ageing from 21 to 87(mean 48.1±17.5)years old were retrospectively ana?lyzed,who were all treated operatively from May 2015 to May 2018 including 130 males and 76 females.19 patients with su?perficial or deep infection of incision within 3 months after the operation were enrolled into the infection group and the other 187 patients without infection were enrolled in the non-infection group.The pathogens of SSI were analyzed in the infection group and potential risk factors were recorded in all the patients,including demographic variables as age,sex,body mass index(BMI),smoking history,complications like hypertension and diabetes;injury-related variables as mechanism of injury,frac?ture type,classification of soft tissue injury,presence of tension vesicle and associated dislocation;surgery-related variables as time from injury to operation,American Society of Anesthesiologists(ASA)class,time of operation,type of internal fixation,intraoperative blood loss,wound closure method and plaster fixation after the operation.The single factor analysis and multivar?iate Logistic regression model were used to analyze the risk factors for SSI after the operation.Results:The incidence of SSI was 9.2%(19/206).The positive rate of bacteria culture in infection group was 94.7%(18/19).Tobacco use(P=0.034),pro?longed operative time(P=0.046)and no application of a cast after the operation(P=0.021)were found to be independent risk factors for SSI after the operation in patients with closed ankle fractures.Conclusions:Smoking cessation before and after the operation,shortening the operation time and early application of a cast after the operation are considered to possibly help pre?vent the happening of SSI after the operation in patients with close ankle fractures.