微创接骨板内固定治疗胫骨远端骨折的切口并发症相关危险因素分析

Factors related to incision complications of internal fixation with minimally invasive bone plate for distal tibial fractures

摘要:

目的  分析微创接骨板内固定（MIPO）治疗胫骨远端骨折的切口并发症发生情况及相关危险因素。方法  选取2010年1月-2014年12月因胫骨远端骨折在该院骨科行MIPO治疗的168例患者为研究对象。将切口感染、内植物突出、畸形愈合、切口延迟愈合甚至不愈合等纳入切口并发症，根据是否发生切口并发症将患者分为并发症组和无并发症组。对患者的基本临床资料（年龄、性别、基础疾病、吸烟史）、骨折相关资料（病因、骨折类型）、手术相关因素（受伤至手术的时间、手术时间及术中出血量）等变量进行评估，分析切口并发症相关危险因素。结果  168例患者中，16例患者术后出现切口并发症，发生率为9.52%。Logistic回归分析显示，年龄>50岁、体重指数≥30 kg/m2、糖尿病史、吸烟史及开放性骨折是发生切口并发症的独立危险因素（■=
1.197、3.408、9.472、8.102和19.805，P =0.018、0.074、0.005、0.006和0.003）。性别、是否为多发伤、手术时间及术中出血量等因素与切口并发症无关。结论  年龄>50岁、糖尿病及吸烟史、开放性骨折是发生切口并发症的高危因素，对该类患者应做好围术期软组织管理，预防切口并发症的发生。

Abstract:

Objective To analyze the incidence and risk factors associated with wound complications in distal tibial fracture patients with minimally invasive percutaneous osteosynthesis (MIPO) fixation. Methods A total of 168 distal tibial fractures treated with minimally invasive percutaneous osteosynthesis in our hospital from January 2010 to December 2014 were selected for this study. The wound infection, internal plant protrusion, deformity healing, delayed wound healing and wound nonunion were included in the wound complications. The patients were divided into complication group and non-complication group according to the occurrence of wound complications. The basic clinical data of the patients (age, gender, basic diseases and smoking history), fracture-related information (etiology and fracture type), and surgery-related factors (time from injury to surgery, operation time and intraoperative bleeding) were evaluated. Results In the 168 patients, postoperative wound complications occurred in 16 cases, the rate was 9.52%. Logistic regression analysis showed that age > 50 years (■ = 1.197, P = 0.018), BMI ≥ 30 kg/m2 (■ = 3.408, P = 0.074), history of diabetes (■ = 9.472, P = 0.005), smoking (■ = 8.102, P = 0.006) and open fractures (■ = 19.805, P = 0.003) were thre independent risk factors for incision complications. Gender, body mass index, multiple injuries or not, operative time or blood loss had no significant correlation with wound complications. Conclusions Age > 50 years, diabetes, smoking history and open fracture are the risk factors for incision complications. To prevent wound complications, peri-operative soft tissue management should be prepared in these patients.