后路腰椎内固定术后手术部位感染的危险因素分析

Analysis of risk factors for surgical site infection after posterior lumbar internal fixation

中文关键词:  后路腰椎内固定术  手术部位感染  危险因素

英文关键词:Posterior lumbar internal fixation  Surgical site infection  Risk factors

中文摘要:

  【摘要】 目的：探讨后路腰椎内固定术后手术部位感染的危险因素，为降低手术部位感染的发生率提供参考依据。方法：回顾我科2016年1月1日～2018年12月31日实施后路腰椎内固定手术的1073例患者，男516例，女557例，年龄18~84岁（54.67±13.23岁），将术后手术部位感染的患者纳入感染组，其余患者纳入非感染组。收集两组患者的性别、年龄、诊断、体重指数（BMI）、合并糖尿病和高血压情况、手术时间、术中出血量、是否输血、吸烟史、术前美国麻醉医师协会（ASA）分级、术前使用激素情况、内固定节段数、是否固定至骶骨或骨盆、是否为翻修手术、手术开始时段等资料，进行单因素分析，对阳性结果进行多因素Logistic回归分析。结果：1073例患者中发生手术部位感染19例，感染发生率为1.77%，其中男11例，女8例，年龄18~77岁（54.89±16.67岁）。单因素分析显示两组肥胖（BMI≥28kg/m2）、合并糖尿病、手术时间、手术开始时段等因素存在统计学差异（P＜0.05）；性别、年龄、疾病种类、合并高血压、出血量、是否输血、吸烟史、术前ASA分级、术前使用激素、内固定节段数、是否固定至骶骨或骨盆、是否为翻修手术等因素无统计学差异（P＞0.05）。多因素Logistic回归结果显示肥胖（OR=6.704，P=0.005）、合并糖尿病（OR=4.071，P=0.008）、较长手术时间（OR=7.102，P=0.000）、手术开始时段为晚间（OR=3.981，P=0.018）是术后手术部位感染的独立危险因素。结论：肥胖、合并糖尿病、较长手术时间、手术开始时段为晚间的患者后路腰椎内固定术后发生手术部位感染的风险较高，应采取有针对性的预防措施，以期最大限度降低术后手术部位感染的发生。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors of surgical site infection after posterior lumbar internal fixation, and to provide reference for reducing the incidence of surgical site infection. Methods: The study reviewed the data of 1073 cases of patients who accepted posterior lumbar internal fixation in our department from January 1, 2016 to December 31, 2018, including 516 males and 557 females, aged 18－84 years (54.67±13.23 years). Infected patients were included in the infection group and the rest were included in the non-infection group. Data such as gender, age, diagnosis, Body mass index(BMI), diabetes, hypertension, duration of operation, blood loss, transfusion, smoking history, American Society of Anesthesiologists(ASA) classification, preoperative steroid use, internal fixation levels, whether fixed on sacrum or pelvis, whether revision operation, starting time of operation were collected for univariate analysis. The positive results were analyzed by multivariate Logistic regression analysis, and the risk factors of infection were identified. Results: Among all patients, 19 cases of surgical site infection occurred, including 11 males and 8 females, aged 18－77 years(54.89±16.67 years), with an infection rate of 1.77%(19/1073). Univariate analysis showed that there were significant differences between the two groups in obesity(BMI≥28kg/m2), diabetes, duration of operation, and starting time of operation(P＜0.05). There were no significant differences in gender, age, diagnosis, hypertension, blood loss, transfusion, smoking history, ASA classification, preoperative steroid use, internal fixation levels, whether fixed on sacrum or pelvis, and whether revision operation(P＞0.05). Multivariate Logistic regression analysis showed that there were statistically significant differences in obesity(OR=6.704, P=0.005), history of diabetes(OR=4.071, P=0.008), long operation time(OR=7.102, P=0.000) and operation starting time at night(OR=3.981, P=0.018). Conclusions: Obesity, diabetes history, long operation duration time and operation starts at night are independent risk factors of surgical site infection after posterior lumbar internal fixation, and targeted preventive measures should be taken to reduce the incidence of postoperative infection.