Zhang Xiaoming, Zhan Xuebin, Zou Peng, An Huixia
Department of Orthopedics, Zhengzhou No. 7 People's Hospital, Zhengzhou, Henan 450000, P.R. China.
Department of Anesthesiology, Zhengzhou Orthopaedics Hospital, Zhengzhou, Henan 450052, P.R. China.
Exp Ther Med. 2017 Aug;14(2):1126-1130. doi: 10.3892/etm.2017.4610. Epub 2017 Jun 15.
We studied the factors related to infection after fixation in the process of bone late healed fracture and explored the factors that could predict the risk of postoperative infection. A total of 100 patients with open fractures of the tibia and fibula diagnosed in Zhengzhou No. 7 People's Hospital from 2007 to 2016 were enrolled in this study. Patients were subjected to staging surgery treatment. We divided them into the infection group (n=52) and the non-infection group (n=48) according to whether or not infection occurred after operation. Pearson correlation was used to analyze the relationship between postoperative infection and preoperative factors, and ROC curve was used to explore the factors which could predict the risk of postoperative infection. As a result, surgical timing and C-reactive protein were correlated with postoperative infection (P<0.05), and surgical timing was negatively correlated with postoperative infection. C-reactive protein was positively correlated with postoperative infection. Using 7 days as the cut-off point of surgical timing, false positive and false negative rates were 0 and 27.7%, respectively. Youden index value was 72.3%, and positive predictive and negative predictive values were 42.5 and 100%, respectively. With 54.55 mg/l as the cut-off point of C-reactive protein, the sensitivity and specificity of prediction were 88.2 and 94.1%, while the false negative and false positive rates were 11.8 and 5.9%, respectively. The Youden index value was 82.3%, and the positive predictive and negative predictive values were 75 and 96.7%, respectively. With 7 days as the cut-off point of surgical timing and 54.55 mg/l as the cutoff point of C-reactive protein at the same time, the positive predictive and negative predictive values were 88.2 and 97.6%, respectively. The false negative and false positive rates were 11.8 and 2.4%, respectively. The Youden index value was 85.8%. The positive predictive and negative predictive values were 88.2 and 97.6%, respectively. In conclusion, surgical timing and C-reactive protein were strongly correlated with postoperative infection and this correlation was not affected by age, sex or other inflammatory indexes. The incidence of postoperative infection was reduced when both factors were applied for the determination of surgery. In addition, incidence of complications will be reduced and the cure rate improved.
我们研究了骨延迟愈合骨折固定术后感染的相关因素，并探索了能够预测术后感染风险的因素。本研究纳入了2007年至2016年在郑州市第七人民医院确诊的100例胫腓骨开放性骨折患者。患者接受分期手术治疗。根据术后是否发生感染，将他们分为感染组（n = 52）和非感染组（n = 48）。采用Pearson相关性分析术后感染与术前因素之间的关系，并用ROC曲线探索能够预测术后感染风险的因素。结果显示，手术时机和C反应蛋白与术后感染相关（P < 0.05），手术时机与术后感染呈负相关，C反应蛋白与术后感染呈正相关。以7天作为手术时机的截断点，假阳性率和假阴性率分别为0和27.7%。约登指数值为72.3%，阳性预测值和阴性预测值分别为42.5%和100%。以54.55mg/l作为C反应蛋白的截断点，预测的敏感性和特异性分别为88.2%和94.1%，而假阴性率和假阳性率分别为11.8%和5.9%。约登指数值为82.3%，阳性预测值和阴性预测值分别为75%和96.7%。同时以7天作为手术时机的截断点、54.55mg/l作为C反应蛋白的截断点时，阳性预测值和阴性预测值分别为88.2%和97.6%，假阴性率和假阳性率分别为11.8%和2.4%。约登指数值为85.8%，阳性预测值和阴性预测值分别为88.2%和97.6%。综上所述，手术时机和C反应蛋白与术后感染密切相关，且这种相关性不受年龄、性别或其他炎症指标的影响。当应用这两个因素来确定手术时，术后感染的发生率降低。此外，并发症的发生率将降低，治愈率将提高。
