脊柱结核术后切口不愈合的危险因素分析

Risk factors for nonunion of incision after spinal tuberculosis surgery

目的通过探讨脊柱结核术后切口不愈合的危险因素,降低术后切口不愈合发生率。方法纳入手术治疗的脊柱结核患者146例。记录患者的基本资料及围术期相关指标,应用多因素Logistic回归分析确定脊柱结核术后切口不愈合的危险因素。结果 146例脊柱结核患者切口愈合122例(83.56%),切口不愈合24例(16.44%)。不愈合组年龄显著大于愈合组,出现脊柱外结核比例高于愈合组,行后前路联合手术比例高于愈合组,手术病灶清除不彻底比例高于愈合组,降钙素原(procalcitonin,PCT)水平高于愈合组,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、手术方法、手术病灶清除程度及PCT水平与脊柱结核术后切口不愈合有关(P<0.05)。结论高龄、前后路联合手术、手术病灶清除不彻底、高PCT水平是脊柱结核术后切口不愈合的危险因素。合理选择手术适应证是降低术后切口不愈合发生率的关键。

Objective To identify the risk factors of postoperative wound nonunion in patients with spinal tuberculosis and to reduce the incidence rate.Methods A total of 146 patients with spinal tuberculosis who underwent surgery were enrolled in this study.The patients basic information and perioperative information were recorded.Multivariate logistic regression analysis was used to analyze the risk factors of wound nonunion after spinal tuberculosis operation.Results Among 146 cases of spinal tuberculosis,122 cases(83.56%)had incision healing and 24 cases(16.44%)had incision nonunion.The age of non-healing group was significantly older than that of healing group,the proportion of extraspinal tuberculosis was higher than that of non-healing group,the proportion of combined posterior and anterior surgery was higher than that of healing group,the proportion of incomplete removal of surgical lesions was higher than that of healing group,and the level of procalcitonin(PCT)was higher than that of healing group,which showed statistical differences(P<0.05).Multivariate logistic regression analysis showed that age,surgical method,extent of lesion clearance and PCT level were risk factors for incision nonunion after spinal tuberculosis surgery(P<0.05).Conclusion Age,combined anterior and posterior surgery,incomplete removal of surgical lesions,and high PCT are risk factors for nonunion of incision after spinal tuberculosis surgery.Reasonable selection of surgical indications is the key to reduce the incidence of incision nonunion after operation.