目的 探索糖尿病桡骨远端骨折钢板固定手术部位感染(SSI)的相关因素。方法 回顾性分析2012-01至2023-06在武警河南总队医院接受腕掌侧锁定钢板固定不稳定桡骨远端骨折合并糖尿病的患者897例。根据是否发生SSI将患者分为两组。采用单因素比较,二分类多因素logistic回归分析SSI的危险因素,采用受试者操作特征(ROC)曲线评估模型的预测能力。结果 897例中,发生SSI 43例(4.79%),单因素比较结果表明,SSI组年龄低于无SSI组,差异有统计学意义(P=0.029),SSI组的男性构成比、吸烟比例、美国麻醉医师协会(ASA)分级、全麻比例、骨移植比例和失血量均高于无SSI组,差异有统计学意义(P＜0.05)。实验室检查方面,SSI组术前白细胞计数高于无SSI组,术前红细胞计数、血红蛋白、血细胞比容、钠离子和白蛋白均低于无SSI组,差异有统计学意义(P＜0.05)。多因素logistic回归分析显示,男性(OR=2.83, 95%CI: 1.33~5.99, P=0.007)、ASA分级Ⅳ级(OR=4.41, 95%CI: 1.47~13.25, P=0.008)、吸烟(OR=2.37, 95%CI: 1.20~4.69, P=0.013)和骨移植(OR=3.20, 95%CI: 1.18~8.68, P=0.022)是发生SSI的独立危险因素。预测模型的ROC曲线下面积为0.771,显示具有良好的区分能力。结论 糖尿病患者接受腕掌侧锁定钢板治疗不稳定桡骨远端骨折时,应重点关注男性、合并严重全身疾病、有吸烟史及需要骨移植的高风险患者。建议术前戒烟,严格优化血糖控制,合理选择骨移植适应证,加强围手术期感染预防措施,并制定个体化监测方案,以降低SSI风险,改善患者预后。
Abstract
Objective To explore the related factors of surgical site infection (SSI) in diabetic patients undergoing plate fixation for distal radius fractures. Methods A retrospective analysis was conducted on 897 patients who suffered from diabetes mellitus and underwent palmar locking plate fixation for unstable distal radius fractures in the Henan Provincial Corps Hospital of Chinese People's Armed Police Force from January 2012 to June 2023. The patients were divided into two groups based on whether SSI occurred. Univariate analysis was used to compare the factors, and binary variable multivariate logistic regression analysis was used to analyze the risk factors of SSI. The receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of the model. Results Among the 897 patients, 43 patients (4.79%) developed SSI. The results of univariate analysis showed that the SSI group was significantly younger than the non-SSI group, and the difference was statistically significant (P=0.029), and the SSI group proved significantly higher than the non-SSI group in terms of proportion of male ,smoking, American Society of Anesthesiologists (ASA) classification, general anesthesia ratio [n, general/region, bone grafting ratio and blood loss, and the differences were statistically significant (P＜0.05). Regarding preoperative laboratory tests, the SSI group had significantly higher white blood cell count, whereas significantly lower red blood cell count, hemoglobin, hematocrit, sodium, and albumin than the non-SSI group, and the differences were statistically significant (P＜0.05). Multivariate logistic regression analysis demonstrated that male gender (OR=2.83, 95%CI: 1.33～5.99, P=0.007), ASA classification Ⅳ (OR=4.41, 95%CI: 1.47～13.25, P=0.008), smoking (OR=2.37, 95%CI: 1.20～4.69, P=0.013), and bone grafting (OR=3.20, 95%CI: 1.18～8.68, P=0.022) were independent risk factors for SSI development. The area under the ROC curve of the predictive model was 0.771, demonstrating good discriminative ability. Conclusions For diabetic patients undergoing palm locking plate treatment for unstable distal radius fractures, special attention should be paid to high-risk patients such as males, those with worsened systemic diseases, those with a smoking history, and those requiring bone grafts. It is recommended to quit smoking before the surgery, strictly optimize blood sugar control, reasonably select indications for bone grafting, strengthen infection prevention measures during the perioperative period, and develop individualized monitoring plans to reduce the risk of surgical site infection and improve patient prognosis.
关键词
糖尿病 /
桡骨远端骨折 /
腕掌侧锁定钢板 /
手术部位感染 /
危险因素
Key words
diabetes /
distal radius fracture /
volar locking plate /
surgical site infection /
risk factors
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