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

English Keywords:Hepatitis B virus  Open posterior instrumented lumbar fusion  Infection  Wound healing  Risk factors

English Abstract:

  【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(+).