腰椎后路术后手术切口早期感染的危险因素分析

Analysis on risk factors of early incision infection after posterior lumbar surgery

目的分析腰椎后路手术术后引起手术切口早期感染的危险因素,以期预防和减少手术切口感染的发生。方法选取2013年1月至2017年6月在东莞市中医院脊柱骨科行腰椎后路减压、椎弓根固定术的420例患者为研究对象,其中11例存在术后手术切口早期感染者为早期切口感染组,其余409例患者为未感染组,比较两组患者的临床资料,采用Logistics多因素回归分析引起手术切口早期感染的危险因素。结果早期切口感染组和未感染组患者的年龄≥60岁(72.73%vs 36.67%)、合并高血压(36.36%vs 13.45%)、术后血红蛋白<90 g/L(81.82%vs31.76%)、手术节段≥3个(72.73%vs 31.78%)、术中出血量≥1 000 m L(63.64%vs 21.76%)、手术时间≥3 h(81.82%vs31.30%)、间断缝合(72.73%vs 35.45%)、术后引流管放置>5 d(81.82%vs 14.43%)的比例比较,早期切口感染组均明显高于未感染组,差异均有统计学意义(P<0.05);Logistics多因素回归分析结果显示,手术节段≥3个、引流管放置超过5 d是引起术后切口早期感染的独立因素(P<0.05)。结论手术节段数量、术后引流管放置时间是腰椎后路手术后早期手术感染的独立危险因素。

Objective To analyze the risk factors of early incision infection after posterior lumbar surgery, in order to prevent and reduce the incidence of incision infection. Methods From January 2013 to June 2017, 420 patients with posterior lumbar decompression and pedicle fixation in Department of Spinal Orthopedics, Dongguan Traditional Chinese Medicine Hospital were selected as the research objects, of which 11 patients with early infection of postoperative incision were selected as the early incision infection group, and the remaining 409 patients were enrolled as uninfected group. The clinical data were compared between the two groups. Logistics multifactor analysis was used to analyze the risk factors of early infection in the surgical incision. Results The ratio of ≥ 60 years old, combination with hypertension, postoperative hemoglobin〈90 g/L, surgical segment〉3, intraoperative bleeding≥1 000 m L, operation time more than 3 h, intermittent suture, and postoperative drainage tube placement〉5 d in early incision infection group were72.73%, 36.36%, 81.82%, 72.73%, 63.64%, 81.82%, 72.73%, 81.82%, respectively, which were significantly higher than 36.67%, 13.45%, 31.76%, 31.78%, 21.76%, 31.30%, 35.45% in uninfected group（P〈0.05）. Logistics multivariate analysis showed that surgical segment〉3 and drainage tube placement〉5 d were the independent factors for early infection of postoperative incision. Conclusion The number of operative segments and postoperative drainage tube placement are independent risk factors for early postoperative infection after posterior lumbar surgery.