腰椎融合术后切口深部感染的危险因素分析

Risk factors for surgical site deep infection after posterior instrumented lumbar fusion

中文关键词:  腰椎退变性疾病  腰椎后路固定融合术  深部切口感染  危险因素

英文关键词:Lumbar degenerative disease  Posterior instrumented lumbar fusion  Surgical site deep infection  Risk factors

中文摘要:

  【摘要】 目的：回顾分析腰椎后路手术深部切口感染与同期手术无感染者的临床资料，探讨深部切口感染的危险因素。方法：回顾分析2013年1月~2018年12月我院脊柱外科接受腰椎后路固定融合术且随访1年以上的腰椎退变性疾病患者。收集所有患者的病历资料，根据切口深部感染诊断标准确定术后深部切口感染病例，将患者分为感染组与非感染组。采用单因素和多因素Logistic回归对两组患者的手术时年龄、性别、体重指数（body mass index，BMI）、吸烟、饮酒、糖尿病、高血压、痛风、尿路感染、肺部疾病，术前血液学指标，手术相关因素，输血量、术后白蛋白、术后留置尿管时间进行分析，确定深部切口感染的危险因素。结果：共有907例患者纳入研究，其中符合切口深部感染诊断标准的患者共20例，男女各10例，平均年龄58.9±7.8岁。单因素分析显示年龄、BMI、饮酒、糖尿病、尿路感染、输血与感染相关；多因素Logistic回归分析（Backward LR法）显示BMI>25kg/m2（P=0.031），既往饮酒（P=0.049），糖尿病（P=0.006），尿路感染（P<0.001），术后引流少（P=0.040），术后输血（P=0.001）是发生深部切口感染的独立危险因素。其中尿路感染、糖尿病、饮酒病史、高BMI是深部切口感染的四个主要的独立危险因素（OR分别为14.92、5.53、3.10、2.78）。结论：术前尿路感染、糖尿病、饮酒病史、BMI>25kg/m2以及术后引流少、输血多是腰椎退行性疾病后路固定融合术后深部切口感染的独立危险因素，针对这些危险因素制定相应的措施，有助于降低切口感染率。

英文摘要:

  【Abstract】 Objectives: Retrospective analysis of the clinical data of deep incision infection in posterior lumbar surgery and no infection in the same period of operation, and to determine the risk factors of deep incision infection. Methods: This study retrospectively analyzed 907 patients with degenerative diseases of the lumbar spine who underwent posterior instrumented lumbar fusion in the spinal surgery department of our hospital from January 2013 to December 2018 and were followed up for more than 1 year. The medical records of all patients were collected, and the cases of postoperative deep incision infection were determined according to the diagnostic criteria of deep incision infection. The patients were divided into the infected group and the non-infected group. Univariate and multivariate Logistic regression was used to analyze the age, sex, body mass index(BMI), smoking, drinking, diabetes, hypertension, gout, urinary tract infection, lung disease, hematological indexes before operation, operation-related factors, blood transfusion volume, postoperative albumin and postoperative indwelling catheter time to determine the risk factors of deep incision infection. Results: A total of 907 patients were included in the study, 20 of whom met the diagnostic criteria for deep incision infection, 10 males and 10 females, with an average age of 58.9±7.8 years. Univariate analysis showed that age, BMI>25kg/m2, alcohol exposure, diabetes mellitus, urinary tract infection and blood transfusion were associated with infection. Multivariate Logistic regression analysis(Backward LR method) showed that BMI>25kg/m2(P=0.031), alcohol exposure(P=0.049), diabetes(P=0.006), urinary tract infection(P<0.001), less postoperative drainage(P=0.040), and postoperative blood transfusion(P=0.001) were independent risk factors for deep incision infection. Urinary tract infection, diabetes, alcohol exposure and BMI>25kg/m2 were the four strongest risk factors for surgical site deep infection(OR 14.92, 5.53, 3.10, 2.78). Conclusions: Preoperative urinary tract infection, diabetes, history of alcohol consumption, BMI>25kg/m2, less postoperative drainage and more blood transfusion are independent risk factors of surgical site deep infection after posterior fixation and fusion of lumbar degenerative diseases, the corresponding measures are helpful to reduce the incision infection rate.