Abstract
Objective To investigate the clinical characteristics and risk factors of secondary fungal osteomyelitis in patients with traumatic fractures,aiming to provide evidence for early clinical prediction.Methods A retrospective analysis was con-ducted on the clinical data of 342 patients with traumatic fractures treated in the Department of Orthopedics,Wuhan Central Hospital of China Construction Third Engineering Bureau,from December 2021 to December 2024.The enrolled patients were divided into a secondary fungal osteomyelitis group and a non-secondary fungal osteomyelitis group according to whether they developed fungal osteomyelitis postoperatively.Differences in baseline characteristics,clinical features,fracture-related factors,surgery-related factors,and routine laboratory indicators were compared between the two groups.Multivariate lo-gistic regression analysis was used to screen independent influencing factors associated with the risk of secondary fungal oste-omyelitis in patients with traumatic fractures,and receiver operating characteristic(ROC)curve was plotted to analyze the value of combined prediction of secondary fungal osteomyelitis by each influencing factor.Results Among the 342 enrolled patients with traumatic fractures,there were 223 males and 119 females,aged 35-69 years,with a median age of 51(47,56)years.Postoperative secondary fungal osteomyelitis occurred in 28 patients,with an incidence of 8.2%.Candida albi-cans was the most prevalent pathogen in secondary fungal osteomyelitis(46.9%).Patients in the secondary fungal osteomy-elitis group had significantly higher values in the following parameters compared to the non-secondary fungal osteomyelitis group(all P<0.05):age,proportion of diabetes mellitus comorbidity,history of corticosteroid use,proportion of Mini-Nu-tritional Assessment score<24,proportion of open fractures,proportion of complete fractures,proportion of unstable frac-tures,proportion of Type C fractures,proportion of severe soft tissue injuries,proportion of wound size>5 cm2,propor-tion of severe wound contamination,surgical timing,proportion of open reduction and internal fixation(ORIF),proportion of plate/screw usage,types and duration of antimicrobial use,white blood cell count on postoperative day 2,and C-reactive protein(P<0.05).Conversely,the secondary fungal osteomyelitis group showed significantly lower values in CD4+T-cell ratio,CD4+T/CD8+T ratio,and natural killer(NK)cell count(P<0.05).Multivariate logistic regression analysis identi-fied the following independent risk factors for secondary fungal osteomyelitis in traumatic fracture patients(P<0.05):dia-betes mellitus[OR(95%CI)=5.21(1.219-22.255)],unstable fractures[OR=5.784(1.336-25.045)],severe soft tissue injuries[OR=3.545(1.390-9.045)],severe wound contamination[OR=5.819(1.190-28.456)],delayed surgical timing[OR=2.774(1.366-5.632)],ORIF[OR=6.631(1.373-32.015)],and C-reactive protein[OR=1.024(1.000-1.048)].ROC curve analysis showed that the area under the curve(AUC)values for independent and combined prediction of seconda-ry fungal osteomyelitis risk by the above risk factors were 0.585,0.597,0.632,0.614,0.625,0.611,0.573,and 0.893,respectively.The combined prediction of the seven factors achieved the highest efficacy,with a sensitivity of 0.847 and spe-cificity of 0.695.Conclusion Diabetes mellitus,fracture type,degree of soft-tissue injury,wound contamination,timing and method of surgery,and inflammation level were all influencing factors for fungal osteomyelitis in traumatic fracture pa-tients.The risk of fungal osteomyelitis in patients could be effectively predicted based on the above-mentioned indicators.关键词
创伤性骨折/真菌性骨髓炎/危险因素Key words
traumatic fractures/fungal osteomyelitis/risk factors分类
医药卫生
