Прогноз инфекционных осложнений в зоне операции при металлоостеосинтезе длинных трубчатых костей

Objective – based on development and use of prognosis and prevention of surgical site infection, to improve the outcomes of metal osteosynthesis in diaphyseal fractures of long bones. Materials and methods . A retrospective analysis of the data on 179 patients who underwent the osteosynthesis for diaphyseal fractures of the long bones was performed. The data on 144 patients who underwent metal osteosynthesis without local infectious complications (group 1) was compared with the data on the patients who had some local infectious complications within one year after the operation (group 2, 35 cases). Based on the retrospective group data, a database was created which became the basis for the mathematical tool of prognosis of local infectious complications in the patients who underwent the metal osteosynthesis for diaphyseal fractures of the long bones. The method of sequential analysis was applied. Software was developed to predict the development of surgical site infection (SSI). This program was tested in a prospective study (117 cases). Results . Totally, 18 criteria for predicting the development of infectious complications in the surgical intervention site were identified.  In terms of the risk of SSI, the following criteria have the predictive significance: gender, age, comorbidities, time of year, type and localization of the fracture, duration of the preoperative period, the risk of anesthesia (preoperative criteria). The intraoperative prognostic factors include information about the duration of operation, intraoperative blood loss, type of osteosynthesis and priority in the operating room. The criterion of postoperative prognosis is the patient's mode. The measures for preventing the local infectious complications in the patients in the risk group were developed. The estimation of the diagnostic effectiveness of the model (according to the retrospective group) revealed that the sensitivity (Se) was 94.3 %, specificity (Sp) – 97.9 %. For the patients with high and moderate risk of SSI we used the individual preventive measures – extended preoperative preparation, optimization of traffic in the operational unit, the implementation of continuous monitoring, drug therapy corresponding to the risk factors of SSI (antibiotic prophylaxis and antibiotic therapy, drugs that improve blood rheology, detoxification therapy, symptomatic therapy and others). Using mathematical modeling, we determined the level of possible development of SSI. In the virtual model, it was predicted in 23 (19.7 %) of 117 patients in the prospective group. The individual preventive measures were used in all these patients. Really, SSI was verified in 11 (9.4 %) patients within one year after surgery. At the same time, there were 8 (6.8 %) cases of superficial infection and 3 (2.6 %) cases of deep infection. Conclusion . The analysis of the received data confirms the correctness of choice of the criteria for predicting SSI during planning the metal osteosynthesis for the long bones. It was found that for at least 12 months after the operation, the incidence of local infectious complications in the operating wound decreased, compared to the frequency in the retrospective study group, from 19.6 to 9.4 % (including deep infectious complications from 5.6 to 2.6 %).