腰椎不稳伴腰椎间盘突出症患者经脊柱融合术后发生切口感染的影响因素

Influencing factors for incision infection in patients with lumbar instability and lumbar disc herniation after transforaminal lumbar interbody fusion

目的 探究腰椎不稳伴腰椎间盘突出症患者经脊柱融合术后发生切口感染的影响因素。方法 选取2017年1月至2023年1月行椎间孔腰椎椎体间融合术治疗的腰椎不稳伴腰椎间盘突出症患者1 620例,通过术后切口感染情况将患者分为感染组32例,未感染组1 588例。检测降钙素原(procalcitonin,PCT)、C-反应蛋白(C-reactive protein,CRP)、红细胞沉降率(erythrocyte sedimentation rate,ESR)、白细胞计数(white blood cell count,WBC)水平;微生物鉴定药敏分析仪来对病原菌进行鉴定。对相关变量进行单因素、多因素logistic回归分析。结果 与未感染组比较,感染组患者PCT、CRP、ESR、WBC水平均升高(P<0.05);感染组患者切口感染的病原菌种类中金黄色葡萄球菌最多为16例(50.00%),其次为粪肠球菌8例(25.00%)、大肠埃希菌6例(18.75%)、阴沟肠杆菌2例(6.25%)。单因素分析显示,手术节段、手术时间、切口长度在腰椎不稳伴腰椎间盘突出症患者术后切口感染中的差异有统计学意义(P<0.05);多因素logistic回归分析显示,多节段手术、手术时间>2 h、切口长度≥4 cm是影响腰椎不稳伴腰椎间盘突出症患者术后切口感染情况的主要危险因素。结论 多节段手术、手术时间>2 h、切口长度≥4 cm为影响腰椎不稳伴腰椎间盘突出症患者术后切口感染情况的主要危险因素,临床应对以上因素及时评估并采取相应措施,以降低患者术后切口感染的发生率。

Objective To explore the influencing factors for incision infection in patients with lumbar instability and lumbar disc herniation after transforaminal lumbar interbody fusion.Methods A total of 1620 patients with lumbar instability and lumbar disc herniation who underwent transforaminal lumbar interbody fusion in our hospital from January 2017 to January 2023 were selected.They were divided into infection group(32 cases) and non-infection(1,588 cases) according to postoperative incision infection.Procalcitonin(PCT),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR) and white blood cell count(WBC) were detected.Pathogens were identified by a drug sensitivity analyzer.Univariate and multivariate logistic regression analysis were performed to identify influencing factors for incision infection in patients with lumbar instability and lumbar disc herniation after transforaminal lumbar interbody fusion.Results Compared with those of non-infection group,PCT,CRP,ESR and WBC in the infection group were significantly higher(P<0.05).In the infection group,the most popular pathogen was Staphylococcus aureus in 16 strains(50.00%),followed by Enterococcus faecalis in 8 strains(25.00%),Escherichia coli in 6 strains(18.75%) and Enterobacter cloacae in 2 strains(6.25%).Univariate analysis showed significant differences in the surgical segment,surgical time and incision length between groups(P<0.05).Multivariate logistic regression analysis showed that multi-stage surgery,operation time >2h and incision length ≥4cm were the main risk factors for postoperative incision infection in patients with lumbar instability and lumbar disc herniation.Conclusion Multi-segment surgery,operation time >2h,incision length ≥4cm are the main risk factors for postoperative incision infection in patients with lumbar instability and lumbar disc herniation.By analyzing the above risk factors,the incidence of postoperative incision infection in patients with lumbar disc herniation can be reduced.