Analysis in risk factors of fever in early stage after pelvic osteotomy for developmental dislocation of hip in children
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摘要:目的 探讨儿童发育性髋关节脱位骨盆截骨术后早期发热的危险因素。方法 回顾性分析142例儿童发育性髋关节脱位(采用Salter骨盆截骨+髋关节切开复位+股骨短缩旋转截骨术)的临床资料。将患儿根据术后早期发热情况分为发热组(n=87)与非发热组(n=55)。比较2组患儿性别、年龄、手术持续时间、体质量、麻醉方式、术后第1天血红蛋白、术后第1天胸片结果、术后第1天白细胞计数、术后第1天降钙素原水平及血C反应蛋白水平等指标。结果 单因素分析结果显示，年龄、术后血红蛋白、体质量是影响儿童骨盆截骨术后早期发热的重要因素(P < 0.05)。多因素Logistic回归分析结果显示，术后血红蛋白≤80 g/L是儿童骨盆截骨术后早期发热的独立危险因素。结论 儿童发育性髋关节脱位骨盆截骨术后出现早期发热的相关危险因素有体质量≤15 kg、年龄≤3岁、术后血红蛋白≤80 g/L, 其中术后血红蛋白≤80 g/L是儿童骨盆截骨术后早期发热的独立危险因素。Abstract:Objective To explore the risk factors of fever in early stage after pelvic osteotomy for developmental dislocation of hip in children.Methods Clinical materials of 142 children with developmental dislocation of hip were analyzed retrospectively, and all the children were treated with Salter pelvic osteotomy plus hip joint open reduction plus femoral shortening rotary osteotomy. The children were divided into fever group (n=87) and non-fever group (n=55) according to the early fever after operation. The gender, age, duration of operation, body mass, anesthesia method, hemoglobin on the first day after operation, chest X-ray result on the first day after operation, white blood cell count on the first day after operation, procalcitonin level and C-reactive protein level on the first day after operation were compared between the two groups.Results Univariate analysis showed that age, hemoglobin level and body mass were important influencing factors of early fever after pelvic osteotomy in children (P < 0.05). Multivariate Logistic regression analysis showed that post-operative hemoglobin ≤ 80 g/L was an independent risk factor of early fever after pelvic osteotomy in children.Conclusion The risk factors of early fever after pelvic osteotomy for developmental dislocation of the hip in children are body mass ≤ 15 kg, age ≤ 3 years, and post-operative hemoglobin ≤ 80 g/L. Postoperative hemoglobin ≤ 80 g/L is an independent risk factor for early fever after pelvic osteotomy in children.
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Keywords:
- developmental dislocation of hip /
- postoperative fever /
- children /
- risk factors
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表 1 发热组与非发热组的临床指标比较
例 变量 发热组(n=87) 非发热组(n=55) χ2 P 性别 男 11 7 0.001 0.988 女 76 48 年龄/岁 ≤3 61 22 21.140 0.001 >3 16 33 手术持续时间/h ≤3 52 32 1.210 0.271 >3 25 23 体质量/kg ≤15 54 27 1.950 0.032 >15 33 28 术后第1天血红蛋白水平/(g/L) ≤80 72 24 23.550 0.001 >80 15 31 术后第1天胸片 较术前改变 44 22 1.510 0.218 与术前胸片无改变 43 33 麻醉方式 静脉全麻+吸入 46 29 0.001 0.986 静脉全麻+吸入+骶麻 41 26 术后第1天白细胞计数/(×109/L) ≤12.0 29 23 1.050 0.307 >12.0 58 32 术后第1天降钙素原水平/(ng/mL) ≤0.05 65 40 0.070 0.793 >0.05 22 15 术后第1天C反应蛋白水平/(mg/L) ≤8 62 38 0.080 0.782 >8 25 17 
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表 2 儿童发育性髋关节脱位骨盆截骨术后早期发热的Logistic多因素分析
变量 β Wald值 P值 OR 95%CI 年龄 0.988 2.592 0.113 3.662 2.876~6.841 术后血红蛋白水平 0.623 4.071 0.017 1.864 1.207~2.879 体质量 0.062 1.259 0.262 1.064 0.954~1.187
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[1] 中华医学会小儿外科分会骨科学组, 中华医学会骨科学分会小儿创伤矫形学组. 发育性髋关节发育不良临床诊疗指南(0~2岁)[J]. 中华骨科杂志, 2017, 37(11): 641-650. doi: 10.3760/cma.j.issn.0253-2352.2017.11.001 [2] 刘柱, 李浩, 张志强, 等. 一期联合手术治疗2~6岁发育性髋关节脱位儿童的临床和影像学结果评价[J]. 中华小儿外科杂志, 2017, 38(7): 511-515. doi: 10.3760/cma.j.issn.0253-3006.2017.07.006 [3] 方继红, 刘永, 武凤芹, 等. 发育性髋关节脱位患儿围术期护理标准流程的应用及效果研究[J]. 中华护理杂志, 2017, 52(9): 1033-1037. doi: 10.3761/j.issn.0254-1769.2017.09.002 [4] 中华医学会骨科学分会. 发育性髋关节发育不良诊疗指南(2009年版)[J]. 2013, 21(9): 953-954. [5] 巴宏军, 李轩狄, 林约瑟, 等. 婴幼儿先天性心脏病术后早期发热的危险因素分析[J]. 中华实用儿科临床杂志, 2017, 32(1): 44-46. doi: 10.3760/cma.j.issn.2095-428X.2017.01.013 [6] 毛琳, 夏琍群, 陈珽, 等. 儿童骨科无菌性手术后高热的危险因素分析[J]. 中华现代护理杂志, 2010, 16(27): 3255-3257. doi: 10.3760/cma.j.issn.1674-2907.2010.27.010 [7] Blumstein G W, Andras L M, Seehausen D A, et al. Fever is common postoperatively following posterior spinal fusion: infection is an uncommon cause[J]. J Pediatr, 2015, 166(3): 751-755. doi: 10.1016/j.jpeds.2014.11.033
[8] 王华锋, 刘恒旸, 王静成. 骨科大手术围手术期贫血状况及血液管理[J]. 中华创伤骨科杂志, 2012, 14(6): 532-535. doi: 10.3760/cma.j.issn.1671-7600.2012.06.016 [9] 李天友, 王延宙, 王恒冰, 等. 血红蛋白<80 g/L作为儿童发育性髋关节发育不良术后输血指征安全性的初步观察[J]. 中国矫形外科杂志, 2014, 22(13): 1182-1185. [10] 卢红信, 陈笑天, 肖玉周. 儿童发育性髋关节脱位的治疗进展[J]. 安徽医药, 2019, 23(4): 738-742. doi: 10.3969/j.issn.1009-6469.2019.04.027 [11] 姜海, 苗武胜, 吴永涛, 等. 可吸收螺钉在大龄儿童发育性髋关节脱位骨盆截骨术中的应用[J]. 美中国际创伤杂志, 2016(1): 9-10, 43. [12] 田琦, 周胜武. Salter骨盆截骨术治疗儿童发育性髋关节脱位疗效观察[J]. 临床军医杂志, 2013, 41(10): 1028-1029, 1031. doi: 10.3969/j.issn.1671-3826.2013.10.14 [13] 黄殿华, 汪文涛, 潘源城, 等. 三角骨块导板在Salter骨盆截骨术治疗儿童发育性髋关节脱位中的应用[J]. 中国骨与关节损伤杂志, 2019, 34(2): 113-116. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201902001.htm [14] 谢国媛. 儿童发育性髋关节脱位Pemberton手术后的康复治疗效果分析[J]. 四川解剖学杂志, 2018, 26(1): 66-67, 70. doi: 10.3969/j.issn.1005-1457.2018.01.024 [15] 朱宇, 施新革, 王红强. 改良Salter截骨术治疗儿童发育性髋关节脱位的临床疗效分析[J]. 医药论坛杂志, 2018, 39(9): 16-17, 20. https://www.cnki.com.cn/Article/CJFDTOTAL-HYYX201809005.htm
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