脊柱后路内固定手术后手术部位感染的危险因素及治疗策略

The risk factors and treatment strategies of surgical site infection after posterior spinal internal fixation surgery

中文关键词:  脊柱后路手术  手术部位感染  危险因素  预防及治疗

英文关键词:Posterior spinal surgery  Surgical site infection  Risk factors  Prevention and treatment

中文摘要:

  【摘要】 目的：探讨脊柱后路内固定手术后手术部位感染的相关危险因素及治疗策略。方法：回顾性分析2015年1月~2018年1月在我院骨科行脊柱后路内固定手术患者3780例。其中男性1970例，女性1810例，年龄18~92岁（44.9±18.4岁），随访1.5±0.3年。根据患者术后1年内是否出现感染分为感染组和非感染组。收集两组患者的年龄（是否＞60岁）、性别、体质指数（body mass index，BMI）（是否＞30kg/m2）、融合节段（是否＞2个）、手术持续时间（是否＞3h）、低蛋白血症（白蛋白是否＜35g/L）、是否贫血、是否合并糖尿病、是否异体输血、术后引流时间（是否＞48h）、失血量（是否＞1000ml）以及是否合并其他部位感染等资料进行独立样本t检验。对阳性结果进行进一步多因素Logistic回归分析，将感染组根据感染灶是否穿破深筋膜分为浅表感染组和深部感染组，收集感染组细菌培养结果，χ2检验分析病原菌构成比。结果：3780例患者中发生手术部位感染患者95例，感染发生率为2.51%，其中男性52例，女性43例，年龄18~82岁（43.5±15.2岁）。单因素分析显示，两组患者在性别、BMI＞30kg/m2、融合节段、贫血、异体输血、术后引流时间以及合并其他感染等因素比较差异无统计学意义（P＞0.05），而在年龄＞60岁、手术时间超过3h、低蛋白血症（白蛋白＜35g/L）、合并糖尿病和失血量＞1000ml等因素存在统计学差异（P＜0.05）。多因素Logistic回归结果显示年龄＞60岁（OR=5.267，P=0.008）、手术时间超过3h（OR=7.156，P=0.000）、低蛋白血症（OR=4.358，P=0.016）、合并糖尿病（OR=3.578，P=0.005）和失血量＞1000ml（OR=4.659，P=0.007）是脊柱后路内固定术后手术部位感染的独立危险因素。95例脊柱后路手术术后手术部位感染患者根据感染部位分为浅表感染65例，深部感染30例，病原菌构成比比较无统计学意义（P＜0.05）。结论：年龄＞60岁、手术时间超过3h、低蛋白血症、合并糖尿病和失血量＞1000ml的患者行脊柱后路内固定手术术后发生切口感染的风险较高，围手术期应积极采取有效的治疗策略，最大限度降低脊柱内固定术后手术部位感染的发生。

英文摘要:

  【Abstract】 Objectives: To explore the risk factors and treatment strategies of surgical site infection after posterior spinal internal fixation surgery. Methods: A retrospective analysis was performed on 3780 patients who underwent posterior spinal internal fixation surgery in the orthopedics department of our hospital from January 2015 to January 2018. There were 1970 males and 1810 females, aged 18-92 years(44.9±18.4 years), with a follow-up of 1.5±0.3 years. Patients were divided into infected group and non-infected group according to whether there was infection after operation. The data of the patients in both groups collected for independent sample t test included: whether aged >60 years old and the gender; whether combined with the body mass index(BMI) >30kg/m2; whether combined with the fusion segments >2; whether combined with the operation time >3h; whether combined with the hypoalbuminemia(albumin <35g/L); whether combined with anemia; whether combined with diabetes; whether combined with allogeneic blood transfusion; whether combined with postoperative drainage time >48; whether combined with the blood loss >1000ml; and whether combined with other site infection. The positive results were further analyzed by multivariate Logistic regression. The infected group was divided into superficial infection group and deep infection group according to the infection site across the deep fascia or not. The bacterial type results of the infected group were collected, and the pathogen composition ratio was analyzed by χ2 test. Results: Surgical site infection occurred in 95 out of the 3780 patients, with an infection incidence of 2.51%, including 52 males and 43 females, aged 18-82 years(43.5±15.2 years). Univariate analysis showed that there was no statistically significant difference between the two groups in gender, BMI >30kg/m2, fusion segment, anemia, allogeneic blood transfusion, postoperative drainage time, and combined with other site infection(P>0.05). However, there were statistically significant differences in age >60 years old, the operation time >3h, hypoproteinemia(albumin <35g/L), diabetes mellitus, and blood loss >1000ml(P<0.05). Multivariate Logistic regression results showed that the age >60 years old(OR=5.267, P=0.008), the operation time >3h(OR=7.156, P=0.000), hypoproteinemia(OR=4.358, P=0.016), diabetes mellitus(OR=3.578, P=0.005) and the blood loss >1000ml(OR=4.659, P=0.007) were independent risk factors for surgical site infection after posterior spinal internal fixation surgery. According to the infection site, the 95 patients with surgical site infection after posterior spinal surgerywere divided into superficial infection (65 cases) and deep infection(30 cases). The constituent ratios of pathogens were not statistically significant(P<0.05). Conclusions: Patients with age >60 years old, operation time >3h, hypoproteinemia, diabetes and blood loss >1000ml after posterior spinal internal fixation surgery have a higher risk of incisional infection. Effective treatment strategies should be actively adopted during the perioperative period to minimize the occurrence of surgical site infection after spinal internal fixation surgery.