摘要
目的对腰椎后路减压椎间融合手术后的深部切口感染(surgical site deep infection,SSDI)病原菌分布特征进行分析,并总结其治疗经验和SSDI发生的相关风险因素。方法回顾性分析本科自2017年9月~2021年9月腰椎后路减压椎间融合手术后并发SSDI的21例患者临床资料,所有患者都接受了彻底清创、冲洗、引流术处理(症状严重者联合负压封闭引流术),并同期接受抗感染治疗,以及病原学检测。将此21例患者列为SSDI组,另按1:3的原则抽取同期于本科手术、但术后未发生SSDI的63例患者列为对照组,收集两组患者的相关人口学资料、临床资料和实验室数据,针对SSDI的潜在相关因素进行分析。结果①疗效:21例患者治疗后,切口顺利愈合,触痛消失。经术后1年以上随访,患者的白细胞计数、血沉和C反应蛋白指标均恢复正常,且内固定稳固、均已实现椎间融合。②病原菌分布特征:21例分离出病原菌26株,其中革兰氏阳性菌17株(65.38%),以金黄色葡萄球菌(57.69%)最为常见;革兰氏阴性菌9株(34.62%),以大肠埃希菌(23.08%)最为常见。③风险因素:多因素Logistic回归分析证实,体质量指数(OR=2.759)、饮酒(OR=3.126)、糖尿病(OR=5.524)和引流管放置时间(OR=1.835),均是腰椎后路减压椎间融合手术后并发SSDI的独立风险因素(P<0.05)。结论腰椎后路减压椎间融合手术后并发SSDI的病原菌分布以革兰氏阳性菌、尤其是金黄色葡萄球菌为主,其次为大肠埃希菌。给予合理的抗生素治疗,充分清创、冲洗引流处理,尽量保留原内固定物,可避免二次或多次清创。SSDI风险因素较多,对于体质量指数偏高、饮酒和合并糖尿病的人群,术后引流时间较长者,应高度警惕SSDI的发生。
Objective To analyze the distribution characteristics of pathogens of surgical site deep infection(SSDI)after lumbar posterior decompression and fusion surgery,and summarize the treatment experience and related risk factors of SSDI.Methods The clinical data of 21 patients with SSDI after posterior lumbar decompression and fusion in our department from September 2017 to September 2021 were retrospectively analyzed.All patients were treated with thorough debridement,flushing and drainage(those with severe symptoms were combined with negative pressure sealing drainage),and received anti infection treatment at the same time.Pathogenic detection was performed after operation.The 21 patients were included in the SSDI group.In addition,63 patients who operated in our department at the same time but did not have SSDI after the operation were randomly selected as the control group according to the 1:3 principle.The relevant demographic data,clinical data and laboratory index data of the two groups of patients were collected,and the potential related factors of SSDI were analyzed.Results①Effect:After treatment,the incisions of 21 patients healed smoothly and the tenderness disappeared.After more than one year of follow-up,the WBC,ESR and CRP of the patients returned to normal,and the internal fixation was stable and interbody fusion was achieved.②Distribution characteristics of pathogenic bacteria:26 strains of pathogenic bacteria were isolated from 21 cases,of which 17 strains were Gram positive bacteria(65.38%),and Staphylococcus aureus(57.69%)was the most common;there were 9 Gram negative bacteria(34.62%),among which Escherichia coli(23.08%)was the most common.③Risk factors:Multivariate logistic regression analysis confirmed that BMI(OR=2.759),alcohol consumption(OR=3.126),diabetes(OR=5.524)and drainage tube placement time(OR=1.835)were independent risk factors for SSDI after posterior lumbar decompression and fusion(P<0.05).Conclusion The clinical management of SSDI after lumbar posterior decompression and fusion
作者
栗磊
苏振炎
张益宏
邱文奎
李晓龙
姬建钧
贾思明
LI Lei;SU Zhen-yan;ZHANG Yi-hong;QIU Wen-kui;LI Xiao-long;JI Jian-jun;JIA Si-ming(The Second Orthopedic Ward of Kaifeng Central Hospital,Kaifeng,Henan 475000,China)
出处
《颈腰痛杂志》
2023年第6期966-970,共5页
The Journal of Cervicodynia and Lumbodynia
关键词
腰椎退行性疾病
切口深部感染
腰椎后路减压椎间融合术
病原菌特征
风险因素
lumbar degenerative disease
deep infection of incision
posterior decompression interbody fusion of the lumbar spine
pathogen characteristics
risk factor
