| 张一龙,孙 宇,王少波,张 立,张凤山,潘胜发,刁垠泽,陈 欣,周非非,赵衍斌,袁晓宁.颈椎后路术后手术部位感染的术中危险因素分析[J].中国脊柱脊髓杂志,2018,(2):106-110. |
| 颈椎后路术后手术部位感染的术中危险因素分析 |
| 中文关键词: 颈椎后路手术 手术部位感染 危险因素 |
| 中文摘要: |
| 【摘要】 目的：探讨颈椎后路术后手术部位感染（surgical site infection， SSI）的术中危险因素。方法：回顾性分析2007年1月~2016年12月在北京大学第三医院骨科颈椎组住院接受颈椎后路手术的患者，患者主要诊断包括脊髓型颈椎病、颈椎外伤、颈椎后纵韧带骨化症等。筛选出术后发生SSI的病例（SSI组）。再从未感染的患者中按1∶4的比例随机抽取对应数量的患者作为对照（非感染组）。收集两组患者的性别、年龄、术前改良JOA（mJOA）评分、术前诊断、手术方式、内科合并症情况、体质量指数（BMI）、吸烟史、术中出血量、术中放置引流管数量、术中回输血量、手术节段以及手术时间等指标进行单因素分析，根据单因素分析结果进行二因素Logistic回归分析，分析与SSI相关的术中危险因素，并进一步使用受试者工作曲线分析确定危险因素的临界值。结果：10年间共有3720例患者在我院骨科颈椎组接受颈椎后路手术，手术方式主要包括颈后路单开门椎管扩大成形术、颈后路单开门椎管扩大成形+侧块螺钉固定术、颈后路椎管后壁切除+侧块螺钉固定术。其中13例患者发生SSI，发生率为0.35％（13/3720），女3例，男10例，年龄为58.38±2.52岁。从未发生SSI的患者中随机抽取52例患者作为对照组（非感染组）。两组患者年龄、性别比、术前mJOA评分、术前诊断、手术方式、内科合并症情况、BMI、术中输血量等均无统计学差异（P＞0.05），吸烟、术中出血量、术中放置引流管数量、手术节段以及手术时间有统计学差异（P＜0.05）。将有统计学差异的五个因素纳入二因素Logistic回归分析，结果显示术中出血量和手术时间为颈椎后路术后SSI的独立术中危险因素；其临界值分别为180ml及84.5min。结论：术中出血量多、手术时间长，术后发生SSI的风险高。 |
Intraoperative risk factors for surgical site infection in posterior cervical surgery |
| 英文关键词:Posterior cervical surgery Surgical site infection Risk factor |
| 英文摘要: |
| 【Abstract】 Objectives: To investigate the intraoperative risk factors for surgical site infection(SSI) in posterior cervical surgery. Methods: A retrospective case-control study of patients following posterior cervical surgery was performed from January 2007 to December 2016. Diagnosis of patients included cervical spondylotic myelopathy, cervical trauma and ossification of posterior longitudinal ligament. Then patients developing deep SSI was compared with a randomly selected group of patients without deep SSI, in order to identify changable risk factors. The clinical data were recorded including gender, age, preoperative mJOA, diagnosis, surgery types, medical co-morbidity, body mass index, smoking, blood transfusion, number of surgical levels, duration of surgery, blood loss and number of drainage tubes. According to the univariate analysis, the significant factors were analyzed with the multifactor Logistic regression analysis. The receiver operating characteristic curve was conducted to identify the optimal cut-off point for the significant factors. Results: 13 cases were identified with deep SSI(CDC criteria) in the study and the overall rate of spinal surgical site infection was 0.35%(13 of 3720) during the ten years. Surgery employed in the study included unilateral open-door lamnioplasty, unilateral open-door lamnioplasty + lateral mass screw fixation and resection of spinal canal posterior wall + lateral mass screw fixation. The 13 cases included 3 females and 10 males with an average age of 58.38±2.52 years. According to the univariate analysis, smoking, number of surgical levels, duration of surgery, blood loss and number of drainage tubes were included for multivariate analysis. The multivariatelogistic regression identified blood loss and duration of surgery as the independent risk factors for SSI, while the optimal cut-off point for blood loss and duration of surgery were 180ml and 84.5min. Conclusions: Blood loss and duration of surgery are identified as the independent risk factors of SSI in posterior cervical operation. |
| 投稿时间：2017-12-17 修订日期：2018-01-28 |
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