乙型肝炎病毒感染对老年患者髋关节置换术后切口愈合的影响

Effect of hepatitis B virus infection on postoperative wound healing in patients with hip arthroplasty

摘要:

目的 探讨乙型肝炎病毒(HBV)感染对老年髋关节置换术患者术后切口愈合的影响,初步分析此类患者切口愈合不良的危险因素。方法 回顾性分析2014年1月至2018年6月解放军中部战区总医院骨科行髋关节置换术患者180例,根据术前是否感染HBV分为HBV感染组和非HBV感染组,所有患者行股骨头置换或全髋关节置换,手术入路为前外侧入路。比较2组患者一般情况、实验室指标、术中和切口情况,并分析HBV感染患者切口愈合不良的危险因素。应用SPSS 19.0统计软件对数据进行分析。依据数据类型组间比较采用独立样本t检验或χ²检验。单因素和多因素logistic回归分析HBV感染患者切口的影响因素。受试者工作特征(ROC)曲线分析白蛋白和术中出血量对HBV感染患者切口愈合不良的预测价值。结果 HBV感染组相比非HBV感染组切口愈合不良比例高[20.0％(18/90) vs 8.9％(8/90)],切口持续渗出时间长[(4.3±1.6) vs(2.5±1.4)d],差异具有统计学意义(P＜0.05)。多因素logistic回归分析结果表明低白蛋白(OR=0.901,95％CI 0.848～0.957; P＜0.001,)和术中出血量较多(OR=4.572,95％CI 1.945～10.746; P=0.010,)是HBV感染患者切口愈合不良的主要危险因素。ROC曲线分析结果表明白蛋白和术中出血量预测HBV感染患者切口愈合不良的曲线下面积(AUC)分别为0.815(95％CI 0.789～0.919,P＜0.001,)和0.766(95％CI 0.682～0.851,P＜0.001),最佳截断点分别为28.2g/L和440ml。结论 HBV感染患者相比非HBV感染患者髋关节置换术后易出现切口愈合不良,主要与低白蛋白和术中出血量较多有关。

Abstract:

Objective To investigate the effect of HBV infection on wound healing in elderly patients undergoing hip arthroplasty, and to preliminarily analyze the risk factors for poor wound healing in these patients. Methods A total of 180 patients undergoing hip arthroplasty in our Orthopedic Department from January 2014 to June 2018 were retrospectively analysed in this study. According to whether having preoperative HBV infection or not, they were divided into HBV infection group and non-HBV infection group. All patients underwent femoral head replacement or total hip arthroplasty with anterolateral approach. The general conditions, laboratory indicators, intraoperative and incision conditions were compared between the 2 groups, and the risk factors for poor incision healing in patients with HBV infection were analyzed. SPSS statistics 19.0 was used to analyze the data. Independent sample t test or Chi-square test was used for comparison between groups based on data types. Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of incision in HBV patients. Receiver operating characteristic (ROC) curve was used to analyze the predictive value of albumin and intraoperative bleeding volume for poor incision healing in HBV patients. Results The incision healing rate [20.0%(18/90) vs 8.9%(8/90)] was statistically higher and persistent exudation time [(4.3±1.6) vs (2.5±1.4)d]significantly longer in the HBV infection group than in the non-HBV infection group (P<0.05). Multivariate logistic regression analysis[JP+1]showed that low albumin (OR=0.901,5%CI 0.848-0.957; P<0.001) and large volume of intraoperative bleeding (OR=4.572, 95%CI 1.945-10.746; P=0.010) were the main risk factors for poor incision healing in the HBV patients. ROC curve analysis indicated that the areas under curve (AUC) of albumin and intraoperative bleeding volume in predicting poor incision healing in these patients were 0.815 (95%CI 0.789-0.919, P<0.001) and 0.766 (95%CI 0.682-0.851, P<0.001), respectively, and the best cut-off points were 28.2g/L and 440 ml, respectively. Conclusion Compared with the non-HBV patients, the patients with HBV infection tend to have poor incision healing after hip arthroplasty, which is mainly related to low albumin and larger intraoperative bleeding.