腰椎后路术后切口感染及椎管内血肿的危险因素分析  

Risk factors of incision infection and spinal canal hematoma after lumbar posterior surgery

作　　者：刘家明[1] 邓辉林[1] 周扬[1] 陈宣银[1] 陈文昭[1] 黄山虎[1] 戴闽[1] 刘志礼[1] 

机构地区：[1]南昌大学第一附属医院骨科,330006

出　　处：《中华骨科杂志》2017年第9期547-552,共6页Chinese Journal of Orthopaedics

基　　金：江西省科技厅人才计划项目（20162BCB22022,20162BCB23057）

摘　　要：目的探讨腰椎后路术后发生切口感染及椎管内血肿的危险因素。方法回顾性分析2010年1月至2014年12月因腰椎疾病行腰椎后路手术术后发生切口感染的33例及发生椎管内血肿的25例患者资料。33例发生切口感染患者中，男20例，女13例；年龄38-79岁，平均（58．85±8．76）岁；原始疾病为间盘突出症5例，滑脱9例，椎管狭窄15例，骨折4例。25例发生椎管内血肿患者中，男17例，女8例；年龄38-77岁，平均（60．96±11．37）岁；原始疾病为间盘突出症18例，滑脱3例，椎管狭窄4例。按患者年龄、性别、原始疾病等进行匹配，从同期行腰椎后路手术患者的数据库中按3：1比例选择术后未发生并发症的患者作为对照组进行数据分析。结果在术后切口感染的患者中，术前合并糖尿病、术前红细胞、血红蛋白、总蛋白、白蛋白、钙离子浓度，手术方式，手术时间，手术节段，术中出血量、植入cage，术后白细胞、红细胞、血红蛋白和血小板浓度与无切口感染组比较差异有统计学意义。进一步分析显示：术前合并糖尿病（OR=3．716，P=0．032）、术前血清钙降低（OR〈0．001，P=0．001）、术中出血量增加（OR=1．002，P=0．014）、术后血红蛋白减少（OR=0．923，P=0．018）和术后血小板升高（OR=1．007，P=0．017）是手术后切口感染的独立危险因素。在术后椎管内血肿形成的患者中，术前总蛋白、白蛋白、血小板、钙离子浓度；手术时间，手术节段，术中出血量、输异体血和术后总蛋白与无血肿组对比差异具有统计学意义。进一步分析显示：术前血清钙降低（OR〈0．001，P=0．001）、术前总蛋白减少（OR=1．298，P=0．043）、术中出血量增加（OR=1．003，P=0．021）和术后总蛋白减少（OR=1．080，P=0．028）是手术后椎管内血肿形成的独立危险因素。结论术前合并糖尿病、血清钙下降、Objective To analyze the risk factors of incision infection and spinal canal hematoma after lumbar spinal posterior surgery. Methods Data of 33 patients with incision infection and 25 patients with spinal canal hematoma after posterior surgery for lumbar spinal disease from January 2010 to December 2014 were retrospectively analyzed. For the patients with inci- sion infection, 20 of them were males and 13 were females, with an average age of 58.85_＋8.76 years （range 38-79 years）. Of these patients, 5 were diagnosed with lumbar disc herniation, 9 with lumbar spondylolisthesis, 15 with lumbar spinal stenosis and 4 with lumbar vertebral fracture. For patients with spinal canal hematoma, 17 of them were males and 8 were females, with a mean age of 60.96±11.37 （range, 38-77）. The diagnoses of them were lumbar disc herniation in 18 patients, spondylolisthesis in 3 patients and spinal stenosis in 4 patients. From the same period database, patients who underwent lumbar posterior lumbar surgery with no post- operative complications were selected by 3 ： 1 ratio as the control group according to age, gender and diagnosis. Results For pa- tients with incision infection, it was found that diabetes mellitus, preoperative RBC, hemoglobin, total protein, albumin, serum cal- cium, operation time, number of segment fusion, intraoperative blood loss, postoperative WBC, RBC, hemoglobin and platelet were significantly different from those with non-infection group. Moreover, multivariate logistic analysis showed that diabetes mellitus （OR=3.716, P=0.032）, preoperative serum calcium （OR〈 0.001, P=0.001）, intraoperative blood loss （OR=1.002, P=0.014）, postop- erative hemoglobin （OR=0.923, P=0.018） and postoperative platelet （OR=1.007, P=0.017） were independent risk factors for post- operative incision infection. For patients with spinal canal hematoma, it was foUnd that patients preoperative total protein, albu-min, serum calcium, platelet, operation time, intraoperative blood loss and postoperative to

关 键 词：腰椎 外科伤口感染 血肿 危险因素 

分 类 号：R687.3[医药卫生—骨科学]