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吸烟和三踝骨折是切开复位内固定治疗闭合性踝关节骨折后感染的危险因素:一项多中心回顾性研究共纳入 1201 例骨折。

Smoking and trimalleolar fractures are risk factors for infection after open reduction and internal fixation of closed ankle fractures: A multicenter retrospective study of 1,201 fractures.

机构信息

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.

出版信息

Injury. 2021 Jul;52(7):1959-1963. doi: 10.1016/j.injury.2021.04.017. Epub 2021 Apr 20.

Abstract

INTRODUCTION

One of the complications of the surgical therapy for ankle fractures includes wound infection. This study aimed to evaluate postoperative function and clarify the risk factors associated with postoperative wound infection in patients receiving the open reduction and internal fixation for ankle fracture through a multicenter study.

SUBJECTS AND METHOD

Among 1421 patients diagnosed as having closed ankle fracture and who were treated by surgical therapy in 11 institutions from 2014 through 2019, 1201 patients (men, n = 512, women, n = 689; the mean (SD) age, 50.9 (15.6) years; the mean body mass index [BMI] (SD), 24.3 (4.2) kg/m2) were included as subjects. Excluded were 220 patients due to self-termination of treatment, inability to follow up after discharge, open fracture, distal tibia shaft fracture, and pilon fracture. We extracted the following as risk factors of wound infection: age, sex, BMI, fracture type, injury energy and histories of smoking, diabetes, arteriosclerosis, heart failure and myocardial infarction. We conducted logistic regression analysis to investigate the risk factors of wound infection using these extracted items as explanatory variables and the presence or absence of wound infection as the response variable.

RESULTS

Wound infection occurred after surgery for closed ankle fracture in 69 the 1201 patients (5.7%). The causative organism was methicillin-susceptible Staphylococcus aureus (MSSA) in 15 patients, methicillin-resistant S. aureus (MRSA) in 4 patients, Finegoldia magna in one patient, and S. haemolyticus in one patient. In the other patients, causative organisms were not detected, culture of the causative organisms was not conducted, or they were unknown. The univariate analysis showed significant differences in sex (p = 0.01) and for smoking (p = 0.002), fracture type (p = 0.02) and heart failure (p = 0.042). Logistic regression analysis showed that smoking and type of fracture (trimalleolar fracture) were significant explanatory factors for infection (odds ratio 1.83 and 1.98, p = 0 .040 and 0.042, respectively).

CONCLUSIONS

At 5.7%, the rate of postoperative wound infection in closed ankle fracture was not low. Staphylococcus was the most frequent causative organism. The surgeon should pay attention infection after surgery in the patients who had a trimalleolar fracture or smoking habits.

摘要

简介

踝关节骨折手术治疗的并发症之一包括伤口感染。本研究旨在通过多中心研究评估接受切开复位内固定治疗的踝关节骨折患者的术后功能,并明确与术后伤口感染相关的危险因素。

受试者和方法

在 2014 年至 2019 年期间,11 家机构共收治 1421 例闭合性踝关节骨折患者,其中 1201 例(男性 n=512,女性 n=689;平均[SD]年龄 50.9[15.6]岁;平均体重指数[BMI] [SD] 24.3[4.2]kg/m2)被纳入研究对象。由于治疗中止、出院后无法随访、开放性骨折、胫骨下段骨折和 Pilon 骨折,排除了 220 例患者。我们提取了以下作为伤口感染的危险因素:年龄、性别、BMI、骨折类型、损伤能量以及吸烟、糖尿病、动脉硬化、心力衰竭和心肌梗死史。我们使用这些提取项目作为解释变量,将伤口感染的存在或不存在作为响应变量,进行逻辑回归分析,以调查伤口感染的危险因素。

结果

1201 例闭合性踝关节骨折患者中,69 例(5.7%)术后发生伤口感染。15 例为耐甲氧西林金黄色葡萄球菌(MSSA),4 例为耐甲氧西林金黄色葡萄球菌(MRSA),1 例为 Finegoldia magna,1 例为溶血性链球菌。在其他患者中,未检测到病原体,未进行病原体培养,或病因不明。单因素分析显示,性别(p=0.01)和吸烟(p=0.002)、骨折类型(p=0.02)和心力衰竭(p=0.042)有显著差异。逻辑回归分析显示,吸烟和骨折类型(三踝骨折)是感染的显著解释因素(比值比 1.83 和 1.98,p=0.040 和 0.042)。

结论

闭合性踝关节骨折术后伤口感染率为 5.7%,并不低。金黄色葡萄球菌是最常见的病原体。对于有三踝骨折或吸烟习惯的患者,外科医生应注意术后感染。

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