影像学脊柱脂肪指数对腰椎后路器械融合术后深部手术部位感染的预测价值

Imaging spinal fat index is an independent risk factor for deep surgical site infection after posterior lumbar instrumentation fusion

目的探讨影像学检查脊柱脂肪指数(SAI)对腰椎后路器械融合术后深部手术部位感染(DSSI)的预测价值。方法选择2018年1月至2020年12月在该院接受腰椎后路器械融合术后发生DSSI的31例患者作为研究组,按照3∶1比例抽取同期在该院行腰椎后路器械融合术后无DSSI的93例患者作为对照组。在腰椎中矢状位T2加权MRI图像上测量患者皮下脂肪厚度和SAI值,观察两组患者皮下脂肪厚度和SAI差异;采用多因素Logistic平衡其他临床资料后,观察SAI与DSSI的关系。结果研究组皮下脂肪厚度和SAI均高于对照组,差异均有统计学意义(P<0.05)。研究组和对照组性别、年龄、体质量指数(BMI)、吸烟、糖尿病、ASA分级、术前类固醇、术前免疫抑制剂、非手术部位感染史、手术节段、手术时间、出血量、术后引流时间等差异存在统计学意义(P<0.05)。多因素Logistic回归分析结果显示,SAI≥0.45、年龄≥75岁、ASA分级>2级、术后引流时间>3 d、手术节段>2节段是DSSI的风险因素(P<0.05)。结论SAI是腰椎后路器械融合术后DSSI的风险因素,可用于术前手术患者的风险分层。

Objective To investigate the relationship between spinal adiposity index(SAI)and deep surgical site infection(DSSI)after lumbar posterior instrumentation fusion.Methods 31 patients with deep SSI(DSSI)after lumbar posterior instrumentation fusion in our hospital from January 2018 to December 2020 were selected as the study group while 93 patients without DSSI after lumbar posterior instrumentation fusion in our hospital in the same period were selected as the control group according to the ratio of 3:1.The subcutaneous fat thickness and Sai of the patients were measured on T2 weighted MRI images in the midsagittal position of the lumbar spine,and the differences of subcutaneous fat thickness and Sai between the two groups were observed.The relationship between Sai and DSSI was observed after multivariate logistic balance of other clinical data.Results The subcutaneous fat thickness and Sai in the study group were significantly higher than those in the control group(P<0.05).There were significant differences in gender,age BMI,smoking,diabetes,ASA classification,preoperative steroids,preoperative immunosuppressive agents,history of non-surgical infection,operative section,operative time,bleeding volume and postoperative drainage time between the study group and the control group(P<0.05).Multivariate logistic analysis showed that Sai≥0.45,age≥75 years,ASA>grade 2,postoperative drainage tube time>3 d and surgical segment>2 segments were the risk factors of DSSI(P<0.05).Conclusion Sai is a risk factor for DSSI after posterior lumbar instrumentation fusion,and its measurement is simple and can be used for preoperative risk stratification.