脊柱结核患者病灶清除植骨融合内固定术后未愈的相关因素分析  

Analysis of related factors of unhealed after debridement and bone graft fusion and internal fixation in patients with spinal tuberculosis

作　　者：李明 桂燃燃 孔德胜 LI Ming;GUI Ranran;KONG Desheng(Department of Orthopedics,Third People's Hospital of Jiujiang City,Jiujiang,Jiangxi,332000,China)

机构地区：[1]九江市第三人民医院骨科,江西九江332000

出　　处：《当代医学》2023年第5期73-76,共4页Contemporary Medicine

摘　　要：目的探究脊柱结核患者病灶清除植骨融合内固定术后未愈的相关因素。方法回顾性分析2018年2月至2020年6月于本接受病灶清除植骨融合内固定术治疗的80例脊柱结核患者的临床资料,分析患者术后恢复情况,比较未愈与愈合患者年龄、性别、营养情况、术前抗结核时间、病灶清除情况及术中、术后情况;多因素Logistic回归分析脊柱结核患者病灶清除植骨融合内固定术后未愈的影响因素。结果未愈与愈合患者年龄、性别、术中大血管损伤情况、术中神经损伤情况、术中输尿管损伤情况、术后血沉检查情况比较差异无统计学意义;未愈患者营养不良、术前抗结核治疗时间<6个月、病灶未完全清除、术后未接受规范化疗、术后未及时发现处理积液、术后脊柱不稳定发生率均高于愈合患者,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示,营养不良、术前抗结核治疗时间<6个月、病灶未完全清除、术后未接受规范化疗、术后未及时发现处理积液、术后脊柱不稳定是脊柱结核患者病灶清除植骨融合内固定术后未愈的独立危险因素(OR>1,P<0.05)。结论引起脊柱结核患者病灶清除植骨融合内固定术后未愈的相关因素较多,主要与患者术前抗结核治疗措施不足、医护人员术中操作不当、术后营养补给、脊柱制动、规范化疗措施未落实相关,医护人员需关注以上影响因素,并及时采取干预措施,以减少术后不愈情况发生。Objective To explore the related factors of unhealed after debridement and bone graft fusion and internal fixation in patients with spi-nal tuberculosis.Methods The clinical data of 80 patients with spinal tuberculosis who received debridement and bone graft fusion and internal fixa-tion from February 2018 to June 2020 were retrospectively analyzed.The postoperative recovery of patients was analyzed,the age,gender,nutrition-al status,preoperative anti-tuberculosis time,lesion debridement and intraoperative and postoperative status of patients with unhealed and healed were compared.Multivariate Logistic regression analysis was used to analyze the influencing factors of unhealed in patients with spinal tuberculosis after debridement and bone graft fusion and internal fixation.Results There were no statistically significant differences in age,gender,intraopera-tive large vascular injury,intraoperative nerve injury,intraoperative ureter injury and postoperative blood sedimentation between the patients with un-healed and healed.The incidence rates of malnutrition,preoperative anti-tuberculosis treatment time<6 months,incomplete lesion debridement,fail-ure to receive standard chemotherapy after surgery,failure to find and treat postoperative effusion in time,and postoperative spinal instability in pa-tients with unhealed were higher than those in patients with healed(P<0.05).Multivariate Logistic regression analysis showed that malnutrition,pre-operative anti-tuberculosis treatment time<6 months,incomplete lesion debridement,failure to receive standard chemotherapy after surgery,failure to find and treat postoperative effusion in time and postoperative spinal instability were independent risk factors of nonunion after debridement,bone graft fusion and internal fixation in patients with spinal tuberculosis(OR>1,P<0.05).Conclusion There are many factors related to nonunion in patients with spinal tuberculosis after debridement,bone graft fusion and internal fixation,and nonunion is mainly related to the insufficient preo

关 键 词：脊柱结核 病灶清除植骨融合内固定 术后不愈 相关因素 

分 类 号：R687.3[医药卫生—骨科学]