PRP局部注射联合血小板凝胶对骨科术后创面愈合的疗效及术后创面感染风险预测模型构建  

Effect of local injection of PRP combined with platelet gel on wound healing after orthopedic surgery and construction of risk prediction model of postoperative wound infection

作　　者：许露萍 芮勇宇[1] 胡超燕 谢佩仪 刘丹丹 赵可伟 郭诗琪 XU Luping;RUI Yongyu;HU Chaoyan;XIE Peiyi;LIU Dandan;ZHAO Kewei;GUO Shiqi(Nanfang Hospital,Southern Medical University,Guangzhou 510000,Guangdong,China;Department of Clinical Laboratory,The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510378,Guangdong,China)

机构地区：[1]南方医科大学南方医院,广东广州510000 [2]广州中医药大学第三附属医院检验科,广东广州510378

出　　处：《西部医学》2025年第2期289-294,共6页Medical Journal of West China

基　　金：2022年广州中医药大学第三附属医院科研创新基金课题(Sy2022012)。

摘　　要：目的 探讨富血小板血浆(PRP)局部注射联合血小板凝胶治疗骨科术后创面愈合的疗效,分析术后创面感染风险影响因素,并构建术后创面感染的预测模型,以验证其预测价值。方法 选取2022年9月—2023年9月本院收治的行骨科手术的患者120例,分为观察组及对照组,每组60例。观察组术后均应用PRP局部注射联合血小板凝胶覆盖创面治疗;对照组术后用PRP局部注射治疗。比较两组患者术后创面愈合的治疗效果。观察组患者依据术后创面是否发生感染将其分为感染组(12例)与未感染组(48例),多因素Logistic回归模型分析骨科术后创面感染风险的相关危险因素;构建骨科术后创面感染风险的列线图预测模型,并评价其预测效能。结果 观察组治疗总有效率较对照组高(P<0.05)。观察组患者中术后发生创面感染12例,感染发生率为20.00%;经Logistic回归分析结果显示,开放性创伤类型、手术时间≥2 h、切口类型Ⅱ~Ⅲ类、抗菌药物联合且使用时间≥7 d、住院时间≥2周、合并糖尿病均是骨科术后患者创面感染的危险因素(OR=5.223、3.655、3.114、3.564、3.469、3.554、3.206,95%CI=1.312~9.144、1.225~6.084、1.354~4.875、1.301~5.828、1.245~5.638、1.245~5.882、1.354~5.058,P<0.001);ROC曲线下面积为0.875(95%CI:0.826~0.963),特异度为85.78%,灵敏度为82.34%;Hosmer-Lemeshow拟合优度检验显示差异无统计学意义(χ^(2)=2.462,P=0.128);构建的列线图预测模型区分度较好,校准度较高。结论 PRP局部注射联合血小板凝胶治疗骨科术后创面愈合的疗效确切,创伤类型、手术时间、切口类型、抗菌药物联合且使用时间、住院时间及合并糖尿病均是骨科术后患者创面感染的危险因素,且构建的预测模型可准确预测术后创面感染发生风险,为采取早期干预措施提供依据。Objective To explore the efficacy of local injection of platelet-rich plasma(PRP) combined with platelet gel in the treatment of postoperative wound healing in orthopedics,and analyze the risk factors of postoperative wound infection,and construct a prediction model of postoperative wound infection to verify its predictive value.Methods A total of 60 patients who underwent orthopedic surgery in our hospital from September 2022 to September 2023 were selected as the observation group,and all of them were treated with local injection of PRP combined with platelet gel covering the wound after operation.In addition,60 patients who underwent orthopedic surgery in the same period were selected as the control group,and treated with local injection of PRP after operation.The therapeutic effects of wound healing after operation in the observation group and the control group were compared.Patients in the observation group were divided into infected group(12 cases) and uninfected group(48 cases) according to whether the wound was infected after operation.Multivariate Logistic regression model was used to analyze the risk factors of wound infection after orthopedic operation.To construct a nomogram prediction model for the risk of wound infection after orthopedic surgery and evaluate its prediction efficiency.Results The total effective rate in the observation group was 93.33%(56/60),which was higher than that in the control group(80.00%,48/60)(P<0.05).Among 60 patients,12 cases had wound infection after operation,and the infection rate was 20.00%.Logistic regression analysis showed that open wound type,operation time ≥2 h,incision type Ⅱ ~ Ⅲ,combined use of antibacterial drugs for ≥7 d,hospitalization time ≥2 weeks,and diabetes mellitus were all risk factors for wound infection after orthopedic surgery(OR=5.223,3.655,3.114,3.564,3.469,3.554,95%CI=1.312~9.144,1.225~6.084,1.354~4.875,1.301~5.828,1.245~5.638,1.245~5.882,1.354~5.058,P<0.001).The area under ROC curve was 0.875(95%CI:0.826 ~ 0.963),the specificity was 8

关 键 词：富血小板血浆 局部注射 血小板凝胶 创面愈合 临床疗效 影响因素 

分 类 号：R683.42[医药卫生—骨科学]