闭合性髌骨骨折髌前筋膜内积气的预测指标及对内固定术后早期感染的影响  

Predictive factors for prepatellar subfascial gas in patients with closed patellar fracture and their impacts on early infection following internal fixation

作　　者：林小龙 王黎明[1] 严飞[1] 葛建飞[1] 倪善军[1] 沙卫平[1] 田守进[1] Lin Xiaolong;Wang Liming;Yan Fei;Ge Jianfei;Ni Shanjun;Sha Weiping;Tian Shoujin(Department of Orthopaedic Surgery,Zhangjiagang Hospital Affiliated to Soochow University,Zhangjiagang 215600,China)

机构地区：[1]苏州大学附属张家港医院骨科,张家港215600

出　　处：《中华创伤骨科杂志》2022年第7期610-616,共7页Chinese Journal of Orthopaedic Trauma

基　　金：江苏省卫生健康委科研项目(Z2021086);苏州市"科教兴卫"青年科技项目(KJXW2020058);苏州市民生科技发展计划(民生科技-医疗卫生应用基础研究)项目(SYSD2020008);张家港市科技支撑计划(社会发展)项目(ZKS2018)。

摘　　要：目的探讨闭合性髌骨骨折髌前筋膜内积气的预测指标及对内固定术后早期感染的影响。方法回顾性分析2018年1月至2021年12月苏州大学附属张家港医院骨科收治的148例闭合性髌骨骨折患者资料。所有患者术前均行膝关节三维CT检查且接受髌骨骨折切开复位内固定治疗。根据患者髌前筋膜内有无积气分为2组:积气组18例,男12例,女6例;年龄(58.3±14.5)岁;无积气组130例,男57例,女73例;年龄(60.5±14.6)岁。从两组患者的性别、年龄、体重指数、受伤机制、AO/OTA分型、糖尿病、原发性高血压、术前中性粒细胞百分比、淋巴细胞百分比、白细胞计数、中性粒细胞计数、淋巴细胞计数、C-反应蛋白、红细胞沉降率、降钙素原、白蛋白中筛选出积气的危险因素,对危险因素制作受试者工作(ROC)曲线明确最佳筛选点;并分析积气对内固定术后早期感染的影响。结果术前中性粒细胞百分比是髌前筋膜内积气的危险因素(P<0.05),术前中性粒细胞百分比预测髌前筋膜内积气的ROC曲线下面积为0.700(95%CI:0.554~0.847),最佳临界值为78.45%,敏感性和特异性分别为0.556和0.831(P=0.006)。积气组术后早期感染发生率高于无积气组,但差异无统计学意义(P=0.058)。积气组抗生素使用时间、换药次数显著高于无积气组,差异均有统计学意义(P<0.05)。结论闭合性髌骨骨折患者术前中性粒细胞百分比>78.45%可作为预测髌前筋膜内积气有效的非影像学指标,髌前筋膜内积气可能更容易发生术后早期感染。Objective To explore the predictive factors for prepatellar subfascial gas in patients with closed patellar fracture and their impacts on the early infection following internal fixation.Methods A retrospective analysis was performed in the 148 patients with closed patellar fracture who had been treated at Department of Orthopaedic Surgery,Zhangjiagang Hospital Affiliated to Soochow University from January 2018 through December 2021.All patients underwent preoperative three-dimensional CT examination of the knee joint and was treated by open reduction and internal fixation of patellar fractures.According to the presence or absence of gas in the prepatellar fascia,the patients were divided into 2 groups.In the gas group of 18 patients,there were 12 males and 6 females with an age of(58.3±14.5)years;in the gas-free group of 130 patients,there were 57 males and 73 females with an age of(60.5±14.6)years.The risk factors for prepatellar subfascial gas were screened out by comparing the gender,age,body mass index,injury mechanism,AO/OTA classification,diabetes,primary hypertension,neutrophil percentage,lymphocyte percentage,white blood cell count,neutrophil count,lymphocyte count,C-reactive protein,erythrocyte sedimentation rate,procalcitonin,and albumin before operation between the 2 groups.A receiver operating characteristic(ROC)curve for risk factors were made to identify the best screening points.The impacts of prepatellar subfascial gas were analyzed on early infection after internal fixation.Results The preoperative neutrophil percentage was the risk factor for prepatellar subfascial gas(P<0.05).The area under the ROC curve of preoperative neutrophil percentage for prediction of prepatellar subfascial gas was 0.700(95%CI:0.554 to 0.847),the optimal critical value was 78.45%,and the sensitivity and specificity were 0.556 and 0.831,respectively(P=0.006).In the gas group,the incidence of early postoperative infection was insignificantly higher(P=0.058),but the time for postoperative antibiotic use was significantly

关 键 词：筋膜 髌骨 骨折固定术 内 外科伤口感染 

分 类 号：R687.3[医药卫生—骨科学]