腰椎间盘突出症术后椎间隙感染的治疗及危险因素分析  

Risk factors and treatment of lumbar disc space infection after discectomy

作　　者：程清平[1] 王东福[1] 焦朋[1] 王力[1] 高学[1] 乔亮荣 许正伟[2] 

机构地区：[1]韩城市人民医院骨科,陕西715400 [2]西安交通大学医学院附属红会医院脊柱外科

出　　处：《中国骨与关节损伤杂志》2017年第1期32-35,共4页Chinese Journal of Bone and Joint Injury

摘　　要：目的探讨腰椎间盘突出症术后椎间隙感染的危险因素及治疗方法。方法回顾性分析自2003-01—2013-12手术治疗的351例腰椎间盘突出症,31例术后椎间隙感染(感染组),320例未感染(未感染组)。31例感染患者中10例采用非手术治疗,21例采用手术治疗。对腰椎间盘突出症术后椎间隙感染的可能因素采用Logistic回归分析法进行单因素和多因素分析。结果 31例随访时间平均5.8(1~11)年。治疗后6个月所有患者MRI检查提示炎症吸收,术后9个月行X线片检查提示椎间植骨融合,末次随访时未发现感染复发。末次随访时VAS评分(t=8.97,P=0.04)、ODI指数(t=8.69,P=0.04)均较治疗前明显改善,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,肥胖(BMI>27 kg/m2)、吸烟、糖尿病、营养不良、免疫功能低下、手术时间长、初次手术复杂是腰椎间盘突出症术后椎间隙感染的危险因素(P<0.05)。结论腰椎间盘突出症术后椎间隙感染的危险因素较多,早期行手术治疗是安全、可靠的。对于轻型椎间隙感染患者,在控制好基础疾病的前提下也可以采取非手术治疗。Objective To investigate the risk factors and treatment of the postoperative lumbar disc space infection after discectomy. Methods A total of 351 cases of lumbar disc herniation were analysed retrospectively from January 2003 to December 2013. Thirty-one cases suffered from postoperative iutervertebral space infection（infection group）, 320 cases did not （not infection group）. Among 31 cases of infection, 10 cases were treated by conservative treatment, 21 cases by surgical treatment. Logistic regression analysis was used to analyze the possible factors of lumbar disc space infection after discectom. Results All the patients were followed up for 5.8 （1-11）years. All cases got the absorption of inflammation 6 months after therapy in MRI and got bone fusion 9 months after the operation. At the last follow-up, all patients found no recurrence of infection. At last follow-up time, VAS score （t =8.97, P =0.04） and ODI index （t =8.69, P =0.04） were significantly improved compared with the pre-treatment （P 〈0.05）. Multivariate Logistic regression analysis showed that obesity （BMI〉27 kg/m2 ）, smoking, diabetes, malnutrition, low immune function, surgery time, and the complexity of initial surgery were the risk factors of postoperative disc space infection （P 〈0.05）. Conclusion The risk factors of the disc space infection after discectomy are complicated, and the operation treatment is safe and reliable. For patients with mild intervertebral space infection, conservative treatment can be taken under the premise of good control of the basic disease.

关 键 词：腰椎间盘突出症 椎间隙感染 危险因素 LOGISTIC回归分析 

分 类 号：R681.5[医药卫生—骨科学]