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 intervertebral space infection after discectomy

作　　者：许正伟[1] 刘团江[1] 何立民[1] 郑永宏[1] 王栋琪[1] 郝定均[1] 董亮[1] 李涛[1] 

机构地区：[1]西安交通大学医学部附属红会医院脊柱外科颈椎病区,710054

出　　处：《美中国际创伤杂志》2017年第1期25-29,共5页U.S.Chinese International Journal of Traumatology

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：回顾性分析白2003年1月至2013年12月手术治疗的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〉27kg／m^2）、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 method of intervertebral space infection after discectomy. Methods： From January 2003 to December 2013, 351 patients with lumbar intervertebral disc protrusion （LIDP） underwent discectomy and 31 of them suffered from postoperative intervertebral space infection. Among the 31 patients, 21 patients were treated by surgical treatment and the rest 10 patients by conservative treatment. Logistic regression analysis was used to analyze the possible factors of intervertebral space infection. Results： All the patients were followed up for 5.8 years （range 1-11 years）. All cases got inflammation absorption 6 months after therapy in MRI and got bony fusion 9 months after operation. At the last follow-up visit, no infection recurrence noted, VAS score （t=-8.97, P=0.04） and ODI index （t=-8.69, P=0.04） were significantly improved, with a significant difference （P〈0.05）. Muhivariate Logistic regression analysis showed that obesity （kg/m^2〉27）, smoking, diabetes, malnutrition, low immune function, long surgery time, and complicated initial surgery were the risk factors of postoperative intervertebral space infection （P〈0.05）. Conclusion： The risk factors of postoperative intervertebral space infection after diseeetomy are complicated, early operation treatment is safe and reliable. For patients with mild intervertebral space infection, conservative treatment can be taken if the basic disease can be controlled satisfactorily.

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：R681.53[医药卫生—骨科学]