创伤性跟骨骨折患者急诊术后并发手术部位深部感染的影响因素分析

Analysis of influencing factors of deep surgical site infection in patients with traumatic calcaneal fracture after emergency operation

摘要:

目的 探讨创伤性跟骨骨折患者急诊术后并发深部手术部位感染（DSSI）的影响因素。方法 回顾性分析2020年1月—2023年12月连云港市第二人民医院急诊外科、创伤骨科、创伤中心收治的82例创伤性跟骨骨折患者的临床资料，均行切开复位内固定术。统计创伤性跟骨骨折急诊手术患者的DSSI发生情况，分析创伤性跟骨骨折患者急诊术后并发DSSI的危险因素及其对创伤性跟骨骨折患者急诊术后并发DSSI的预测价值。结果 并发组体质量指数（BMI），切口清洁度Ⅲ、Ⅳ度占比、手术时间，术前血清白细胞计数（WBC）和中性粒细胞计数（NEUT）水平均高于未并发组（P 0.05）。多因素一般Logistic回归分析结果显示：切口清洁度为Ⅲ、Ⅳ度［O^R =5.613（95% CI：1.918，16.421）］、BMI值高［O^R =1.395（95% CI：1.084，1.795）］、手术时间长［O^R =1.018（95% CI：1.000，1.036）］、WBC水平高［O^R =2.862（95% CI：1.653，4.956）］和NEUT水平高［O^R =1.302（95% CI：1.022，1.659）］均为创伤性跟骨骨折患者急诊术后并发DSSI的危险因素（P 0.05）。五项联合预测创伤性跟骨骨折患者急诊术后并发DSSI的曲线下面积为0.988（95% CI：0.971，1.000），敏感性为96.00%（95% CI：0751，0.964），特异性为72.60%（95% CI：0.598，0.831）。结论 切口清洁度Ⅲ、Ⅳ度，高BMI值，手术时间长，高WBC及高NEUT水平均为创伤性跟骨骨折患者急诊术后并发DSSI的危险因素，如若出现上述情况，需警惕术后DSSI的发生风险。

Abstract:

Objective To analyze the factors influencing postoperative deep surgical site infection (DSSI) in patients with traumatic calcaneal fractures following emergency surgery.Methods A retrospective analysis was conducted on the clinical data of 82 patients with traumatic calcaneal fractures admitted to the Emergency Surgery, Orthopedic Trauma, and Trauma Center of Lianyungang Second People's Hospital between January 2020 and December 2023. All patients underwent open reduction and internal fixation. The incidence of DSSI was recorded. Risk factors for postoperative DSSI and the predictive value of relevant indicators were analyzed.Results A comparison between the complication group and the non-complication group regarding BMI, the composition of wound cleanliness, operative time, and preoperative serum WBC and NEUT levels, using the χ² /t -test, showed statistically significant differences (P 0.05). The complication group had higher BMI, a higher proportion of wound cleanliness grades III-IV, longer operative time, and higher preoperative serum WBC and NEUT levels compared to the non-complication group. Multivariate general Logistic regression analysis results showed that wound cleanliness grade III-IV [O^R = 5.613 (95% CI: 1.918, 16.421) ], high BMI [O^R = 1.395 (95% CI: 1.084, 1.795) ], long operative time [O^R = 1.018 (95% CI: 1.000, 1.036) ], high WBC level [O^R = 2.862 (95% CI: 1.653, 4.956) ], and high NEUT level [O^R = 1.302 (95% CI: 1.022, 1.659) ] were all risk factors for postoperative DSSI in patients with traumatic calcaneal fractures (P 0.05). The AUC value for the combination of these five factors predicting postoperative DSSI in patients with traumatic calcaneal fractures was 0.988 (95% CI: 0.971, 1.000), with a sensitivity of 96.00% (95% CI: 0.751, 0.964) and a specificity of 72.60% (95% CI: 0.598, 0.831).Conclusion Incision cleanliness grade III~IV, high BMI, prolonged surgery time, and high preoperative levels of WBC and NEUT are independent risk factors for DSSI following emergency surgery for traumatic calcaneal fractures. The presence of these factors should alert clinicians to an increased risk of postoperative DSSI.