摘要
目的分析创伤性下肢骨折(TLEF)患者内固定术后手术部位感染(SSI)的病原学和危险因素,构建预测模型评估其对SSI的预测价值。方法回顾性分析2018年1月—2021年12月笔者医院骨科收治的264例TLEF患者,其中男性184例,女性80例;年龄36~80岁,平均54.5岁;体质量指数18.8~28.9kg/m^(2),平均24.03kg/m^(2);骨折原因:道路交通伤107例,摔伤103例,高处坠落伤54例。根据内固定术后是否SSI分为感染组和未感染组,收集所有患者临床资料并分析感染组病原菌分布情况。多因素Logistic回归分析TLEF患者内固定术后SSI的影响因素,H-L检验预测模型拟合度,受试者工作特征(ROC)曲线分析构建的预测模型对TLEF患者内固定术后SSI的预测价值。结果264例TLEF患者内固定术后47例发生SSI,SSI发生率为17.80%。共检出病原菌51株,革兰氏阳性菌16株,革兰氏阴性菌35株。多因素Logistic回归分析显示,年龄≥60岁、吸烟、开放性骨折、糖尿病、卧床时间≥7d、术后引流管留置时间≥3d为TLEF患者内固定术后SSI的危险因素,白蛋白≥35g/L为保护因素(P<0.05)。以多因素Logistic回归所保留的变量,构建TLEF患者内固定术后SSI预测模型,H-L拟合优度检验P>0.05。ROC分析结果:该模型预测患者内固定术后SSI的曲线下面积为0.869,Youden指数为0.646,灵敏度为91.50%,特异度为73.10%。结论TLEF患者固定术后SSI的病原菌以革兰氏阴性菌为主,年龄、吸烟、骨折类型、糖尿病、卧床时间、术后引流管留置时间、白蛋白是TLEF患者内固定术后SSI的影响因素,根据多因素Logistic回归分析构建的预测模型对TLEF患者内固定术后SSI的预测能效较好。
Objective To analyze the pathogeny and risk factors of surgical site infection(SSI)after internal fixation in patients with traumatic lower extremity fractures(TLEF),and to construct a predictive model to assess its predictive value for SSI.Methods A total of 264 patients with TLEF admitted to our hospital from Jan.2018 to Dec.2021 were selected retrospectively,including 184 males and 80 females;their age ranged from 36 to 80 years(mean,54.5 years);body mass index:18.8-28.9kg/m^(2)(mean 24.03kg/m^(2));fracture causes:107 cases of road traffic injuries,103 cases of fall injuries,and 54 cases of high falling injuries.All patients were divided into infected and uninfected groups according to whether they had SSI after internal fixation.Clinical data were collected and the distribution of pathogenic bacteria in the infected group was analyzed.Multivariate Logistic regression analysis was used to analyze the influencing factors of SSI after internal fixation in patients with TLEF.H-L test was used to test the goodness of fit of the prediction model,and the predictive value of the constructed model to predict SSI after internal fixation in patients with TLEF was analyzed by receiver operating characteristic curve(ROC).Results SSI occurred in 47 cases after internal fixation in 264 patients with TLEF,and the incidence of SSI was 17.80%.A total of 51 pathogenic strains were detected,16 Gram-positive and 35 Gram-negative strains.Multivariate Logistic regression analysis showed that age≥60 years,smoking,open fractures,diabetes,bed time≥7 days,postoperative drainage tube retention time≥3 days were risk factors for SSI after internal fixation in patients with TLEF,albumin>35g/L was protective factor(P<0.05).Using the variables retained by multivariate Logistic regression,the prediction model of SSI after internal fixation in patients with TLEF was constructed.H-L goodness of fit test showed P>0.05.Results of the ROC analysis showed:the model predicted an area under the curve of 0.869 and a Youden index of 0.646 for SSI after internal fixation in patients,with a sensitivity of 91.50%and a specificity of 73.10%.Conclusion The pathogeny of SSI after internal fixation in patients with TLEF are mainly Gram-negative bacteria.Age,smoking,fracture type,diabetes,bedtime,postoperative drainage tube retention time and albumin are the influencing factors of SSI after internal fixation in patients with TLEF.According to multivariate Logistic regression analysis,the prediction effect of the constructed model of SSI after internal fixation in patients with TLEF is better.
作者
罗小红
朱洪
叶丽聪
Luo Xiaohong;Zhu Hong;Ye Licong(Department of Orthopaedics,Guangxi Fangchenggang Traditional Chinese Medicine Hospital(Fangchenggang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine),Fangchenggang,Guangxi 538021,China)
出处
《创伤外科杂志》
2022年第8期589-595,共7页
Journal of Traumatic Surgery
基金
广西壮族自治区卫生和计划生育委员会自筹经费科研课题(Z20170951)。
关键词
下肢骨折
内固定
手术部位感染
病原学
预测模型
lower extremity fractures
internal fixation
surgical site infection
pathogeny
predictive model
