皮下脂肪厚度对腰椎后路术后发生手术部位感染的影响

Effects of thickness of subcutaneous fat on the surgical site infection after lumbar posterior approach

目的探讨皮下脂肪厚度对腰椎后路术后发生手术部位感染(SSI)的影响。方法回顾性分析2010年5月至2015年5月行腰椎后路手术的282例患者的临床资料,收集患者相关危险因素的资料(包括手术节段数、体重指数、糖尿病)及腰4水平椎板到皮肤的距离、皮下脂肪厚度及两者的比值,分析其与术后SSI发生的相关性。结果282例患者中发生SSI 14例,发生率4.96%。糖尿病(P=0.024)、肥胖(P=0.002)、手术节段数(P=0.005)与腰椎术后发生SSI显著相关,同时皮下脂肪层厚度(P=0.0 03)、皮下脂肪厚度与椎板到皮肤距离的比值(P=0.013)亦是腰椎术后发生SSI的独立危险因素,且随着比值的增加,其感染风险增大。结论国人皮下脂肪层厚度及其与椎板到皮肤距离的比值是腰椎术后发生SSI的独立危险因素,术前应当注意评估。

Objective To observe the effects of thickness of subcutaneous fat on the incidence rates of surgical site infection （ SSI ） after lumbar posterior approach.Methods The clinical data about 282 patients who underwent lumbar posterior approach in our hospital from May 2010 to May 2015 were retrospectively analyzed.The data of related risk factors including diabetes mellitus, body mass index （ BMI） , number of vertebrae involved in operation, as well as the horizontal distance from lamina of vertebra at L4 to skin surface and the thickness of subcutaneous fat at surgical site were collected, moreover,the correlation between these parameters and incidence rates of SSI was analyzed.Results Among 282 patients, 14 patients developed postoperative infections,with the incidece rate being 4.96%.The diabetes mellitus, obesity,number of vertebrae involved in operation were closely correlated to the incidence rates of SSI after operation （ P 〈0.05 or P 〈0.01） , moreover,the thickness of subcutaneous fat and the ratio of subcutaneous fat thickness/distance from lamina of vertebra to skin surface were also independent risk factors in occurrence of SSI after operation.Conclusion The thickness of subcutaneous fat at surgical site and the horizontal distance from lamina of vertebra to skin surface are independent risk factors in occurrence of SSI after operation,thus,these factors should be evaluated seriously before operation.