胫骨平台骨折切开复位内固定术后手术部位感染
Surgical site infection after open reduction and internal fixation of tibial plateau fractures.
作者信息
Lin Shishui, Mauffrey Cyril, Hammerberg E Mark, Stahel Philip F, Hak David J
机构信息
Department of Orthopaedic Surgery, School of Medicine, Denver Health Medical Center, University of Colorado Denver, 777 Bannock Street, MC 0188, Denver, CO, 80204, USA.
出版信息
Eur J Orthop Surg Traumatol. 2014 Jul;24(5):797-803. doi: 10.1007/s00590-013-1252-8. Epub 2013 Jun 11.
OBJECTIVE
The aim of this study was to identify risk factors for surgical site infections and to quantify the contribution of independent risk factors to the probability of developing infection after definitive fixation of tibial plateau fractures in adult patients.
METHODS
A retrospective analysis was performed at a level I trauma center between January 2004 and December 2010. Data were collected from a review of the patient's electronic medical records. A total of 251 consecutive patients (256 cases) were divided into two groups, those with surgical site infections and those without surgical site infections. Preoperative and perioperative variables were compared between these groups, and risk factors were determined by univariate analyses and multivariate logistic regression. Variables analyzed included age, gender, smoking history, diabetes, presence of an open fracture, presence of compartment syndrome, Schatzker classification, polytrauma status, ICU stay, time from injury to surgery, use of temporary external fixation, surgical approach, surgical fixation, operative time, and use of a drain.
RESULTS
The overall rate of surgical site infection after ORIF of tibial plateau fractures during the 7 years of this study was 7.8% (20 of 256). The most common causative pathogens was Staphylococcus aureus (n=15, 75%). Independent predictors of surgical site infection identified by multivariate analyses were open tibial plateau fracture (odds ratio=3.9; 95% CI=1.3-11.6; p=0.015) and operative time (odds ratio=2.7; 95% CI=1.6-4.4; p<0.001). The presence of compartment syndrome (odds ratio=3.4; 95% CI=0.7-15.9; p=0.119), use of temporary external fixation (odds ratio=0.5; 95% CI=0.2-1.7; p=0.298), and ICU stay (odds ratio=1.0; 95% CI=1.0-1.1; p=0.074) were not determined to be independent predictors of surgical site infection.
CONCLUSIONS
Both open fracture and operative time are independent risks factors for postoperative infection.
目的
本研究旨在确定手术部位感染的危险因素，并量化成年患者胫骨平台骨折确定性固定术后独立危险因素对感染发生概率的影响。
方法
于2004年1月至2010年12月在一级创伤中心进行回顾性分析。通过查阅患者电子病历收集数据。共251例连续患者（256例病例）被分为两组，即有手术部位感染组和无手术部位感染组。比较两组术前和围手术期变量，通过单因素分析和多因素逻辑回归确定危险因素。分析的变量包括年龄、性别、吸烟史、糖尿病、开放性骨折情况、骨筋膜室综合征情况、Schatzker分类、多发伤状态、重症监护病房（ICU）住院时间、受伤至手术时间、是否使用临时外固定、手术入路、手术固定方式、手术时间以及是否使用引流管。
结果
在本研究的7年期间，胫骨平台骨折切开复位内固定术后手术部位感染的总体发生率为7.8%（256例中的20例）。最常见的致病病原体是金黄色葡萄球菌（n = 15，75%）。多因素分析确定的手术部位感染独立预测因素为开放性胫骨平台骨折（比值比 = 3.9；95%可信区间 = 1.3 - 11.6；p = 0.015）和手术时间（比值比 = 2.7；95%可信区间 = 1.6 - 4.4；p < 0.001）。骨筋膜室综合征的存在（比值比 = 3.4；95%可信区间 = 0.7 - 15.9；p = 0.119）、使用临时外固定（比值比 = 0.5；95%可信区间 = 0.2 - 1.7；p = 0.298）和ICU住院时间（比值比 = 1.0；95%可信区间 = 1.0 - 1.1；p = 0.074）未被确定为手术部位感染的独立预测因素。
结论
开放性骨折和手术时间均为术后感染的独立危险因素。
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