Ma Ju-Lei, Xu Yun-Qin, Shen Tu-Gang, Li Qiang
The Fourth Department of Orthopaedics, the 98th Hospital of PLA, Huzhou 313000, Zhejiang, China;
Zhongguo Gu Shang. 2017 Oct 25;30(10):896-900. doi: 10.3969/j.issn.1003-0034.2017.10.004.
To analyze the risk factor of infection for complex tibial plateau fractures after operation.
Totally clinical data of 293 patients with complex tibial plateau fractures underwent open reduction and internal fixation were retrospectively analyzed from September 2010 to March 2015, including 199 males and 94 females, ranging in age from 17 to 80 years old with an average of 47.3 years old. The possible risk factors such as gender, age, smoking, diabetes, type of fracture(open/closed), classification of open fracture(Gustilo-Anderson classification), classification of soft tissue injury in closed fracture (Tscherne-Gotzen classification), fracture classification(Schatzker V/VI), osteofascial compartment syndrome, ASA score, anesthesia, timing of surgery, operative time(<=150 min/>150 min), surgical approach, combined approach or not, internal fixation site were studied. The multivariate Logistic regression model was used to analyze the risk factors.
Twelve patients were infected of all 293 patients after operation, the infection rate was 4.10%. Univariate analysis showed that fracture type(χ ² =14.496, =0.001), fracture classification(χ²=4.560, =0.033), osteofascial compartment syndrome(χ²=15.631, =0.001), operative time(χ²=11.233, =0.001) were correlated with complex tibial plateau fractures postoperative infection. Multivariate analysis showed that open fractures(χ²=9.696, =0.002) and osteofascial compartment syndrome(χ²=9.119, =0.003) were complex tibial plateau fracture risk factors for infection after operation.
Open fractures and osteofascial compartment syndrome are risk factor of complex tibial plateau fracture for infection after operation. While through debridement for open fracture patients, early diagnosis and promt treatment for osteofascial compartment syndrome could reduce incidence of infection.
分析复杂胫骨平台骨折术后感染的危险因素。
回顾性分析2010年9月至2015年3月期间293例行切开复位内固定术的复杂胫骨平台骨折患者的临床资料,其中男性199例,女性94例,年龄17至80岁,平均47.3岁。研究性别、年龄、吸烟、糖尿病、骨折类型(开放性/闭合性)、开放性骨折分类(Gustilo-Anderson分类)、闭合性骨折软组织损伤分类(Tscherne-Gotzen分类)、骨折分类(Schatzker V/VI)、骨筋膜室综合征、ASA评分、麻醉方式、手术时机、手术时间(<=150分钟/>150分钟)、手术入路、是否联合入路、内固定部位等可能的危险因素。采用多因素Logistic回归模型分析危险因素。
293例患者术后12例发生感染,感染率为4.10%。单因素分析显示骨折类型(χ² =14.496,P =0.001)、骨折分类(χ²=4.560,P =0.033)、骨筋膜室综合征(χ²=15.631,P =0.001)、手术时间(χ²=11.233,P =0.001)与复杂胫骨平台骨折术后感染相关。多因素分析显示开放性骨折(χ²=9.696,P =0.002)和骨筋膜室综合征(χ²=9.119,P =0.003)是复杂胫骨平台骨折术后感染的危险因素。
开放性骨折和骨筋膜室综合征是复杂胫骨平台骨折术后感染的危险因素。对开放性骨折患者进行清创,对骨筋膜室综合征进行早期诊断和及时治疗可降低感染发生率。