老年腰椎退行性疾病患者后路融合和内固定术后切口感染的危险因素分析  

Risk factors analysis of surgical site infection after posterior fusion and internal fixation for senile lumbar degenerative diseases

作　　者：贺国宇 季兴华 冯皓宇 邢泽军 柳青青 He Guoyu;Ji Xinghua;Feng Haoyu;Xing Zejun;Liu Qingqing(Department of Orthopaedics,Shanxi Bethune Hospital(Shanxi Academy of Medical Sciences),Taiyuan 030032,China)

机构地区：[1]山西白求恩医院(山西医学科学院)骨科,太原030032

出　　处：《中华老年医学杂志》2022年第12期1502-1507,共6页Chinese Journal of Geriatrics

摘　　要：目的探讨老年腰椎退行性疾病患者后路椎间融合内固定术后切口感染的危险因素。方法病例对照研究,分析山西白求恩医院骨科2019年1月至2021年12月因腰椎退行性疾病行腰椎后路椎间融合内固定术老年患者的临床资料。术后发生切口感染的18例纳入感染组,与同期未发生切口感染的老年患者按照1∶3比例随机抽取54例,纳入非感染组。收集患者的一般资料、手术相关资料、围术期实验室指标,进行组间单因素分析,筛查与切口感染相关的指标,纳入二元Logistic回归分析,选取与术后切口感染相关的危险因素中的计量资料进行受试者工作特征曲线(ROC)分析。结果感染组和非感染组患者手术时间(197.1±39.5)min比(171.4±37.2)min、术前淋巴细胞数(1.6±0.5)×10^(9)/L比(1.9±0.6)×10^(9)/L、术后中性粒细胞数[7.2(6.2~9.5)×10^(9)/L比6.3(4.8~7.2)×10^(9)/L]、中性粒细胞百分比(82.5±8.8)%比(71.1±6.7)%、淋巴细胞数(1.1±0.6)10^(9)/L比(1.7±0.7)10^(9)/L、淋巴细胞百分比(11.0±5.6)%比(19.8±6.0)%、中性粒细胞数与淋巴细胞数比值(NLR)[8.5(5.2~15.0)比3.6(2.6~4.9)]、血清白蛋白浓度(31.4±2.5)g/L比(33.3±2.4)g/L,差异有统计学意义(均P<0.05)。Logistic回归分析结果显示,糖尿病、手术时间、术后中性粒细胞百分比是老年患者腰椎退行性疾病后路椎间融合内固定术后切口感染的危险因素(P<0.05)。ROC分析结果显示,手术时间的曲线下面积为0.680,临界值为177.5 min。术后中性粒细胞百分比的曲线下面积为0.841,临界值为78.85%。结论腰椎退行性疾病后路椎间融合内固定术患者合并糖尿病、手术时间长、术后中性粒细胞百分比增高可增加切口感染风险。Objective To explore the risk factors of surgical site infection after posterior lumbar interbody fusion and internal fixation in elderly patients with lumbar degenerative diseases.Methods The clinical data of elderly patients who underwent posterior lumbar interbody fusion and internal fixation for degenerative diseases of lumbar spine in Department of Orthopedics,Shanxi Bethune Hospital from January 2019 to December 2021 were retrospectively analyzed.Eighteen elderly patients with postoperative incision infection were included into the infection group,and according to the ratio of 1∶3,54 elderly patients without incision infection during the same period were randomly selected and included in the non-infection group.The general data of patients,surgical related data and perioperative laboratory indexes were compared between groups using univariate analysis.The screened out indicators with close correlation with incision infection and with significantly statistical significance were included in binary Logistic regression analysis.Risk factors related to postoperative incision infection were analyzed by receiver operating characteristic curve(ROC).The quantitative data of risk factors related to postoperative incision infection were selected for receiver operating characteristic curve(ROC)analysis.Results When comparing the infected versus non-infected groups,the operative time was(197.1±39.5)min vs.(171.4±37.2)min,preoperative lymphoid count was(1.6±0.5)×10^(9)/L vs.(1.9±0.6)×10^(9)/L,and postoperative neutrophil count was[7.2(6.2-9.5)×10^(9)/L vs.6.3(4.8-7.2)×10^(9)/L],percentage of neutrophils(82.5±8.8),%vs.(71.1±6.7),percentage of lymphocytes(1.1±0.6)×10^(9)/L vs.(1.7±0.7)×10^(9)/L,percentage of lymphocytes(11.0±5.6)%vs.(19.8±6.0)%,number of neutrophils vs.Lymphocyte count ratio(NLR)[8.5(5.2-15.0)vs.3.6(2.6-4.9)]and serum albumin concentration(31.4±2.5)g/L vs.(33.3±2.4)g/L,all P<0.05.Logistic regression analysis showed that diabetes mellitus(OR=6.649,95%CI:1.233-35.853),operation time(OR=1.

关 键 词：腰椎 内固定器 感染 危险因素 

分 类 号：R687.3[医药卫生—骨科学]