目的分析腰椎后路融合术后手术部位感染(surgical site infection,SSI)的危险因素。方法收集我院2014年1月至2018年10月实施后路腰椎椎间融合术的324例患者资料,根据是否发生SSI分为SSI组与非SSI组,对两组患者的年龄、体质量指数(body m...目的分析腰椎后路融合术后手术部位感染(surgical site infection,SSI)的危险因素。方法收集我院2014年1月至2018年10月实施后路腰椎椎间融合术的324例患者资料,根据是否发生SSI分为SSI组与非SSI组,对两组患者的年龄、体质量指数(body mass index,BMI)、术区皮下脂肪和椎旁肌厚度、吸烟、饮酒、糖尿病、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、血液学资料、手术时间、手术节段、术后引流、脑脊液漏(cerebrospinal fluid leakage,CSFL)等资料进行单因素分析,然后对差异有统计学意义(P<0.05)的因素进行多因素Logistic分析以确定SSI的独立危险因素。结果本组324例中,14例发生 SSI,发生率为4.32%。单因素分析显示BMI、术区皮下脂肪厚度、术前ASA分级≥Ⅲ级、术前血清白蛋白浓度、术后血红蛋白浓度、手术时间、手术节段数、术后引流量、引流时间、CSFL与SSI相关。多因素Logistic回归分析显示术区皮下脂肪厚度、术前血清白蛋白浓度、术后引流时间是发生SSI的独立危险因素(P<0.05)。结论术区皮下脂肪厚度较厚、术前血清白蛋白水平较低、术后引流时间较长的患者腰椎后路融合术后发生SSI的风险较高,应采取针对性的措施以降低SSI的发生率。展开更多
Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for ...Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result. Methods One hundred and ten cases （107 patients） of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved. Results One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley＇s Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system. Conclusion As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.展开更多
文摘目的分析腰椎后路融合术后手术部位感染(surgical site infection,SSI)的危险因素。方法收集我院2014年1月至2018年10月实施后路腰椎椎间融合术的324例患者资料,根据是否发生SSI分为SSI组与非SSI组,对两组患者的年龄、体质量指数(body mass index,BMI)、术区皮下脂肪和椎旁肌厚度、吸烟、饮酒、糖尿病、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级、血液学资料、手术时间、手术节段、术后引流、脑脊液漏(cerebrospinal fluid leakage,CSFL)等资料进行单因素分析,然后对差异有统计学意义(P<0.05)的因素进行多因素Logistic分析以确定SSI的独立危险因素。结果本组324例中,14例发生 SSI,发生率为4.32%。单因素分析显示BMI、术区皮下脂肪厚度、术前ASA分级≥Ⅲ级、术前血清白蛋白浓度、术后血红蛋白浓度、手术时间、手术节段数、术后引流量、引流时间、CSFL与SSI相关。多因素Logistic回归分析显示术区皮下脂肪厚度、术前血清白蛋白浓度、术后引流时间是发生SSI的独立危险因素(P<0.05)。结论术区皮下脂肪厚度较厚、术前血清白蛋白水平较低、术后引流时间较长的患者腰椎后路融合术后发生SSI的风险较高,应采取针对性的措施以降低SSI的发生率。
文摘Background Operative decision-making of Pilon fractures are of great challenges until now. The aim of this study was to investigate the guidance of the four-column theory in decision-making therapeutic strategies for Pilon fractures and its result. Methods One hundred and ten cases （107 patients） of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Among all the 110 cases, single column of 14 cases, two columns of 46 cases, three columns of 17 cases, and all of four columns of 33 cases are involved. Results One hundred and eight cases have been followed up. The average follow up time is 14.7 months, varying between 7 and 52 months. The average healing time is 3.6 months, ranging from 2.5 to 8.0 months. Reduction of 86.1% reviewed Pilon cases are good or acceptable according to Burwell and Charley＇s Radiology Evaluation System. Ankle function of 87.1% cases are excellent or good according to the AOFAS evaluation system. Conclusion As a simple and comprehensive classification, the four-column classification can contribute to reasonable operation decision-making and good prognosis of Pilon fracture.
