全髋关节置换术后伤口愈合不良危险因素分析

目的探讨全髋关节置换术后患者切口愈合不良的相关危险因素，为临床决策提供指导。 方法回顾性分析2017年1月至2019年7月西安交通大学第二附属医院骨关节外科收治的单侧、新发股骨颈骨折、髋关节关节炎及股骨头坏死等并行单侧全髋关节置换或翻修患者，排除合并肿瘤、严重营养不良、经治疗后血糖、血压不能达到标准、合并凝血功能障碍或其他血液系统疾病、近期感染病史及局部皮肤条件较差的患者。根据术后是否发生伤口愈合不良分为两组。比较两组患者之间年龄、性别、身体质量指数(BMI)、术前白蛋白水平、糖尿病、高血压、长期激素应用史、术区多次手术史、手术时间、术前抗凝、术中皮下电刀止血、术后24 h引流量、术后是否输血等相关因素对伤口愈合的影响，应用R语言及Empower Stats统计软件对数据进行分析。依据数据类型，组间比较采用独立样本t检验或卡方检验；利用多因素logistic回归对不同危险因素进行分析，计算各因素比值比(OR)及95%置信区间(CI)。 结果本研究共纳入研究对象432例，其中术后发生伤口愈合不良事件患者43例。年龄(t＝2.907，P<0.05)、BMI(t＝15.399，P<0.001)、糖尿病(χ²＝111.86，P<0.001)、术区多次手术(χ²＝50.135，P<0.001)、长期激素应用史(χ²＝144.31，P<0.001)、手术时间(t＝12.334，P<0.001)及术后是否输血(χ²＝88.725，P<0.001)在两组之间差异有统计学意义。将单因素分析中差异有统计学意义的因素及术前白蛋白水平、皮下电刀止血等纳入多因素logistic回归分析中发现，年龄OR＝1.784，95% CI＝(1.254，2.234)，P＝0.006]、BMI OR＝2.587，95%CI＝(1.647，4.950)，P＝0.016]，手术时间OR＝8.643，95%CI＝(2.331，15.471)，P＝0.001]及术区多次手术OR＝3.218，95%CI＝(2.461，4.339)，P＝0.041]是全髋关节术后发生伤口愈合不良的独立危险因素。 结论高龄、肥胖、手术时长及术区多次手术是全髋关节置换术后伤口愈合不良发生的独立危险因素，对存在有这些因素的患者，应早期诊断治疗。

Risk factors of poor wound healing after total hip arthroplasty

ObjectiveTo explore the related risk factors of poor wound healing after total hip arthroplasty, so as to provide guidance for clinical decision-making. MethodsA retrospective analysis was performed on the patients who underwent total hip arthroplasty in the department of Bone and Joint surgery of the Second Affiliated Hospital of Xi’An Jiaotong University from January 2017 to July 2019. The study included the patients with unilateral, new-onset femoral neck fractures, hip arthritis, and femoral head necrosis who had undergone unilateral total hip replacement or revision, and excluded the patients with tumors, severe malnutrition, abnormal level of blood glucose and blood pressure after treatment that could not meet the standards, coagulation dysfunction or other blood system diseases, recent history of infection and poor local skin conditions. All the patients were divided into two groups according to whether the postoperative wound healing was poor or not. Age, sex, body mass index (BMI), preoperative albumin level, diabetes, high blood pressure, hormone application history, multiple surgery history, operation time, preoperative anticoagulation, intraoperative subcutaneous electrotomehemostasis, drainage within 24 h and postoperative blood transfusion after surgery were collected and compared between two groups using R language and Empower Stats statistical software. Independent sample t test or chi-square test was used for comparison between groups according to data type. Univariate and multivariate logistic regression were used to analyze different risk factors by calculating odds ratio and confidence interval of various factors. ResultsA total of 432 patients were included in this retrospective study, including 43 patients with postoperative poor wound healing. In univariate analysis, there were statistically significant differences in age (t=2.907, P<0.05), BMI(t=15.399, P<0.001), diabetes (χ²=111.86, P<0.001), multiple surgery history (χ²=50.135, P<0.001), hormone application history (χ²=144.31, P<0.001), operation time (t=12.334, P<0.001) and postoperative blood transfusion after surgery(χ²=88.725, P<0.001) between the two groups.The factors with statistical difference in univariate analysis, preoperative albumin level, subcutaneous electrosurgical hemostasis and intraoperative subcutaneous electrotome hemostasis were included in multivariate logistic regression analysis. The results showed that age OR=1.784, 95%CI=(1.254, 2.234), P=0.006], BMIOR=2.587, 95%CI=(1.647, 4.950), P=0.016], operative time OR=8.643, 95%CI=(2.331, 15.471), P=0.001] and multiple surgery history OR=3.218, 95%CI=(2.461, 4.339), P=0.041] were independent risk factors for poor wound healing after total hip arthroplasty. ConclusionsAge, BMI, operation time and multiple surgery history are independent risk factors for poor wound healing after total hip arthroplasty. For patients with these factors, early diagnosis and treatment is necessary.