Quadrant通道下微创经椎间孔腰椎椎间融合术后手术部位感染的危险因素分析

Risk factors of surgical site infection after minimally invasive transforaminal lumbar interbody fusion under Quadrant tube

中文关键词:  微创经椎间孔腰椎椎体间融合术  手术部位感染  并发症  危险因素

英文关键词:Minimally invasive transforaminal lumbar interbody fusion  Surgical site infection  Complications  Risk factors

中文摘要:

  【摘要】 目的：探讨Quadrant通道下微创经椎间孔腰椎椎间融合术（minimally invasive transforaminal lumbar interbody fusion，MIS-TLIF）术后手术部位感染（surgical site infection，SSI）的危险因素。方法：收集2015年1月～2018年12月在重庆市梁平区人民医院行Quadrant通道下MIS-TLIF治疗的患者资料，将术后发生SSI的患者纳入SSI组，于同期未发生SSI患者中按照1∶4比例随机抽取对照患者纳入无感染组。对文献报道常见的脊柱术后感染高危因素进行资料收集，包括两组患者的一般资料：年龄、性别、体重指数（BMI）、吸烟史、合并糖尿病和高血压病情况、腰椎疾病类型，术前血清学指标：糖化血红蛋白、血清白蛋白、血清球蛋白、红细胞、白细胞、血小板、血钾、血钙，手术相关指标：手术时间、术中出血量、手术节段、融合节段数。对上述资料进行组间单因素分析，筛选出具有统计学差异的指标纳入二分类Logistic回归，分析与SSI相关的危险因素，并选取OR值最高的因素进行受试者工作特征曲线 （receiver operating characteristic curve，ROC）分析。结果：共纳入679例患者，其中25例发生SSI，发生率为3.68%（25/679），纳入SSI组。随机抽取同期100例未发生SSI的患者纳入无感染组。单因素分析结果显示两组患者年龄、BMI、吸烟史、合并糖尿病、糖化血红蛋白、血清白蛋白、手术时间、术中出血量、融合节段数有统计学差异（P<0.05），而性别比、合并高血压病、腰椎疾病类型、血清球蛋白、红细胞、白细胞、血小板、血钾、血钙、手术节段无统计学差异（P>0.05）。Logistic回归分析结果表明年龄（OR＝1.077，95%CI 1.003~1.156，P=0.042）、BMI（OR＝1.251，95%CI 1.004~1.559，P=0.046）、糖化血红蛋白（OR＝2.368，95%CI 1.457~3.801，P<0.001）、血清白蛋白（OR＝0.877，95%CI 0.773~0.977，P=0.044）、手术时间（OR＝1.026，95%CI 1.003~1.050，P=0.029）是MIS-TLIF术后SSI的相关危险因素，ROC曲线显示糖化血红蛋白的临界值为7.60％。结论：高龄、肥胖以及术前高糖化血红蛋白、低血清白蛋白、手术时间长会增加MIS-TLIF术后SSI发生的风险。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors of surgical site infection(SSI) after minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF) under Quadrant tube. Methods: The data of patients who underwent MIS-TLIF under Quadrant tube in Department of Orthopaedics, Liangping District People′s Hospital, from January 2015 to December 2018 was collected in the retrospective study. The patients with SSI after operation were enrolled in SSI group. In the same period, the patients without SSI were randomly selected as non-infected group according to 1:4 ratio. The risk factors of infection after spinal surgery in previous studies were collected, including demographics, such as age, sex, body mass index(BMI), smoking, diabetes mellitus, hypertension,lumbar disease type, and preoperative laboratory serological markers: glycosylated hemoglobin, serum albumin, serum globulin, red blood cells, white blood cells, thrombocyte, serum potassium, serum calcium, and operation related markers: operation time, intraoperative blood loss, operation level, number of fusion segments. The above data were analyzed by univariate analysis between the two groups, and the indicators with significant statistical differences were screened and further analyzed in the Binary Logistic regression to explore the risk factors related to SSI, and drew the receiver operating characteristic curve(ROC). Results: A total of 679 patients were enrolled, 25 of whom had SSI and were assigned to the SSI group, the incidence of SSI was 3.68%(25/679). Meanwhile, 100 blank control patients without SSI were randomly selected and assigned to the non-infected group. Univariate analysis showed that age, BMI, smoking, diabetes mellitus, glycosylated hemoglobin, serum albumin, operation time, intraoperative blood loss, and number of fusion segments were significantly different between the two groups(P<0.05), while there was no significant difference in sex ratio, hypertension, lumbar disease type, serum globulin, red blood cells, white blood cells, thrombocyte, serum potassium, serum calcium, and operation level(P>0.05). Logistic analysis showed that age(OR＝1.077, 95%CI 1.003-1.156, P=0.042), body mass index(OR＝1.251, 95%CI 1.004-1.559, P=0.046), glycosylated hemoglobin(OR＝2.368, 95%CI 1.457-3.801, P<0.001), serum albumin(OR＝0.877, 95%CI 0.773-0.977, P=0.044) and operation time(OR＝1.026, 95%CI 1.003-1.050, P=0.029) were risk factors of SSI after MIS-TLIF. The cut-off value of glycosylated hemoglobin on ROC curve was 7.60%. Conclusions: Elderly patients, obesity, preoperative high glycosylated hemoglobin, low serum albumin and long operation time increase the risk of surgical site infection after MIS-TLIF.