乙肝病毒感染对腰椎后路单节段开放融合固定术切口愈合的影响及相关因素分析

Influence of HBV infection on wound healing of incision after single-level open posterior instrumented lumbar fusion and correlated factors analysis

中文关键词:  乙型肝炎病毒  腰椎后路开放融合固定术  感染  切口愈合  危险因素

英文关键词:Hepatitis B virus  Open posterior instrumented lumbar fusion  Infection  Wound healing  Risk factors

中文摘要:

  【摘要】 目的：对比观察乙肝病毒（hepatitis B virus，HBV）感染者与非HBV感染者腰椎后路单节段开放融合固定术后切口愈合情况，探讨HBV感染对切口愈合的影响及相关因素。方法：回顾分析2011年1月～2016年6月我院收治并因腰椎退变性疾病行单节段腰椎后路开放融合固定术患者共1562例，其中HBV感染者148（9.5％）例，根据纳入排除标准最终共121例纳入观察组；以同样纳入排除标准随机选择与观察组年龄、性别、手术时间段相匹配121例非HBV感染患者作为对照组。比较两组患者切口愈合情况；比较观察组中切口愈合不良（乙级愈合：切口红肿、渗出、硬结、血肿、脂肪液化、裂开；丙级愈合：切口感染）患者与切口愈合良好（甲级愈合）患者年龄、性别、体重指数（BMI）、手术时间、术中出血量、淋巴细胞总数、肝功能异常（AST＞40U/L或ALT＞50U/L）、HBV-DNA（+）情况。结果：观察组121例患者中，乙级愈合11例，丙级愈合5例；对照组121例中，乙级愈合4例，丙级愈合2例。观察组与对照组切口感染率差异无统计学意义（P＞0.05），观察组与对照组切口愈合不良差异有统计学意义（P＜0.05）。观察组中切口愈合不良组与切口愈合良好组患者性别、年龄、手术时间、淋巴细胞总数无统计学差异（P＞0.05）；术前肝功能异常病例数、HBV-DNA（+）病例数、术中出血量有统计学差异（P＜0.05）。观察组术后HBV再激活23例，与未激活患者相比年龄、手术时间、术中出血、HBV-DNA（+）病例数差异有统计学意义（P＜0.05）。结论：HBV感染患者行腰椎后路单节段开放融合固定术切口愈合不良发生率较非HBV感染者更高；肝功能异常（AST＞40U/L或ALT＞50U/L）、HBV-DNA（+）、术中出血多是HBV感染者切口愈合不良的危险因素。腰椎后路单节段开放融合固定术可导致乙肝病毒再激活，与年龄较大、手术时间较长、术中出血较多、术前HBV-DNA（+）有关。

英文摘要:

  【Abstract】 Objectives: To observe and compare the wound healing of single-level open posterior instrumented lumbar fusion incision between hepatitis B virus(HBV) infected patients and non HBV infected patients, and to explore the influence of HBV infection on wound healing of incision and related factors. Methods: A retrospective study of 1562 patients who were diagnosed of lumbar degenerative diseases following single-stage instrumented fusion was performed from January 2011 to June 2016. Among 148(9.5%) patients with HBV, 121 patients were selected as observation group after exclusion. 121 patients without HBV infected were randomly selected as the control group matching age, gender and operation period. The wound healing of incision in the observation group and the control group were compared. Age, gender, BMI, operation time, blood loss, the amount of total lymphocyte, liver dysfunction(AST＞40U/L or ALT＞50U/L) and HBV-DNA(+) were compared between poor wound healing group and good healing group in HBV infected patients. Results: Among the 121 patients in the observation group, there were 11 patients of grade B healing and 5 of grade C healing. In the control group, there were 4 patients of grade B healing and 2 of grade C healing. There was no statistical difference in incision infection between the observation group and the control group(P>0.05), while there was statistically significant difference in the poor wound healing(P<0.05). In the observation group, there was no significant difference in gender, age, operation time or the amount of total lymphocyte between the patients with poor wound healing and those with good wound healing(P>0.05). While there were statistical difference(P<0.05) in the number of liver dysfunction cases, HBV-DNA(+) cases and the blood loss between the poor wound healing group and the good wound healing group. There were 23 patients of HBV reactivation in the observation group, and the differences in age, operation time, blood loss and HBV-DNA(+) were statistically significant compared to those in the inactive group(P<0.05). Conclusions: Patients with HBV infection undergoing single-level open posterior instrumented lumbar fusion have a higher incidence of poor wound healing than non HBV infected, and the liver dysfunction, HBV-DNA(+), blood loss are risk factors for poor wound healing in HBV infected patients. Single-level open posterior instrumented lumbar fusion can lead to reactivation of HBV, which is related to older age, longer operation time, more blood loss and preoperative HBV-DNA(+).