腰椎闭合性骨折术后切口愈合不良相关因素分析

韩帅; 赵宇朋; 周平辉; 肖玉周

doi:10.16766/j.cnki.issn.1674-4152.002044

腰椎闭合性骨折术后切口愈合不良相关因素分析

doi: 10.16766/j.cnki.issn.1674-4152.002044

韩帅^{1, 2},
赵宇朋^{1, 2},
周平辉^{1, 2},
肖玉周^{1, 2, ,}

1.
蚌埠医学院第一附属医院骨科，安徽蚌埠 233004
2.
安徽省组织移植重点实验室，安徽蚌埠 233000

基金项目:

国家自然科学基金项目 31700854

详细信息

通讯作者:
肖玉周, E-mail: XiaoYuzhou1@aliyun.com

中图分类号: R683.2
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- 文章访问数: 315
- HTML全文浏览量: 126
- PDF下载量: 6
- 被引次数: 0
出版历程
- 收稿日期: 2020-12-11
- 网络出版日期: 2022-02-16

Analysis of related factors of poor wound healing after closed lumbar fracture surgery

HAN Shuai^{1, 2},
ZHAO Yu-peng^{1, 2},
ZHOU Ping-hui^{1, 2},
XIAO Yu-zhou^{1, 2
, ,}

1.
Department of Orthopedics, the First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, China

摘要

摘要: 目的本实验通过对腰椎闭合性骨折术后切口愈合不良的相关危险因素进行分析和探讨，以减少术后切口愈合不良的发生。方法选取2017年5月—2020年5月蚌埠医学院第一附属医院骨科342例腰椎闭合性骨折的患者为研究对象，回顾性分析术后出现切口愈合不良的患者，对切口愈合不良的发生率及相关危险因素进行研究分析。结果 (1) 342例患者中出现28例切口愈合不良，切口愈合不良的发生率为8.2%。单因素分析结果显示患者性别、切口长度、电刀使用、术前术后抗菌药物的使用及引流管引流时间对术后切口愈合情况没有影响，差异无统计学意义(均P＞0.05)；患者年龄>45岁、手术时间＞3 h、糖尿病、高血压、BMI＞28、腰背部脂肪厚度＞3 cm与术后切口愈合不良有明显相关性，差异有统计学意义(均P＜0.05)。(2)以切口愈合不良为因变量，利用多因素logistic回归分析发现患者年龄、手术时间、糖尿病、高血压、体重指数、腰背部脂肪厚度是腰椎闭合性骨折术后切口愈合不良的独立危险因素。(3)28例切口愈合不良的患者中，切口感染最为常见，所占比为57.14%；其中金黄色葡萄球菌为最常见的感染细菌，所占比为37.5%。结论患者年龄、手术时间、糖尿病、高血压、体重指数、腰背部脂肪厚度是腰椎闭合性骨折术后切口愈合不良的危险因素。
- 腰椎骨折 /
- 闭合 /
- 愈合不良 /
- 预防
Abstract: Objective To investigate and analyse the related risk factors of poor incision healing after operation for lumbar closed fracture. Methods A total of 342 patients with closed lumbar fracture who were admitted to the department of orthopaedics in the First Affiliated Hospital of Bengbu Medical College from May 2017 to May 2020 were included in the study. The incidence of poor incision healing and related risk factors were studied and analysed retrospectively. Results (1) Among the 342 patients, 28 cases had poor incision healing, with an incidence of 8.2%. Univariate analysis showed that gender, the length of incision, use of electric knife, use of antibiotics before and after the operation and drainage time of the drainage tube had no effect on postoperative incision healing, and the difference was not statistically significant (all P>0.05). Age of >45 years, operation time of >3 h, diabetes, hypertension, BMI of >28 and waist and back fat thickness of >3 cm were significantly correlated with poor wound healing after operation. (2) Multi-factor logistic regression analysis showed that age, operation time, diabetes, hypertension, body mass index and low back fat thickness were independent risk factors for poor incision healing after operation for lumbar closed fracture when poor wound healing was used as a dependent variable. (3) Among the 28 patients with poor wound healing, incision infection was the most common, accounting for 57.14%. Staphylococcus aureus was the most common infection bacteria, accounting for 37.5%. Conclusion Patients' age, operation time, diabetes, hypertension, body mass index and low back fat thickness are the risk factors for poor incision healing after lumbar closed fracture operation.
- Lumbar fracture /
- Closure /
- Poor healing /
- Prevention

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表 1 腰椎闭合性骨折术后切口愈合不良单因素分析 [例(%)]

变量	例数	切口是否愈合不良		χ²值	P值
变量	例数	是	否	χ²值	P值
年龄				5.070	0.024
＞45岁	200	22(11.0)	178(89.0)
≤45岁	142	6(4.2)	136(95.8)
腰背部脂肪厚度				11.728	0.001
＞3 cm	140	20(14.3)	120(85.7)
≤3 cm	202	8(4.0)	194(96.0)
糖尿病病史				19.857	< 0.001
有	134	22(16.4)	112(83.6)
无	208	6(2.9)	202(97.1)
高血压病史				23.074	< 0.001
有	146	24(16.4)	122(83.6)
无	196	4(2.0)	192(98.0)
电刀使用情况				7.440	0.006
有	160	20(12.5)	140(87.5)
无	182	8(4.4)	174(95.6)
切口长				7.655	0.006
＞5 cm	136	18(13.2)	118(86.8)
≤5 cm	206	10(4.9)	196(95.1)
手术时间				20.394	< 0.001
＞3 h	154	24(15.6)	130(84.4)
≤3 h	188	4(2.1)	184(97.9)
术后抗菌药物使用时间				2.902	0.088
＞3 d	218	22(10.1)	196(89.9)
≤3 d	124	6(4.8)	118(95.2)
肥胖(BMI＞28)				7.875	0.005
是	182	22(12.1)	160(87.9)
否	160	6(3.8)	154(96.2)
性别				2.185	0.139
男	192	12(6.3)	180(93.7)
女	150	16(10.7)	134(89.3)
引流时间				0.017	0.897
＞3 d	126	10(8.0)	116(92.0)
≤3 d	216	18(8.3)	198(91.7)

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表 2 切口愈合不良相关因素多因素logistic回归分析

变量	B	SE	Wald χ²	P值	OR值	95% CI
年龄	1.188	0.547	4.720	0.030	3.280	1.123~9.575
高血压	1.023	0.444	5.316	0.021	2.783	1.166~6.643
糖尿病	1.097	0.458	5.743	0.017	2.955	1.221~7.347
手术时间	1.008	0.462	4.760	0.029	2.741	1.108~6.781
脂肪厚度	1.190	0.516	5.310	0.021	3.287	1.195~9.042
BMI	1.298	0.627	4.283	0.038	3.622	1.071~12.521
注：各变量赋值情况，年龄：≤45岁=0，＞45岁=1；高血压：否=0，是=1；糖尿病：否=0，是=1；手术时间≤3 h=0，＞3 h=1；脂肪厚度：≤3 cm=0，＞3 cm=1；BMI：≤28=0，＞28=1。

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表 3 术后切口愈合不良患者细菌培养感染所占比

病原菌	株数	构成比(%)
革兰氏阳性菌	9	56.25
金黄色葡萄球菌	6	37.50
表皮葡萄球菌	2	12.50
凝固酶阴性葡萄球菌	1	6.25
革兰氏阴性菌	7	43.75
大肠埃希菌	3	18.75
阴沟肠杆菌	2	12.50
铜绿假单胞菌	1	6.25
鲍氏不动杆菌	1	6.25
真菌	0	0.00
合计	16	100.00

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参考文献(20)

[1]	胡海涛, 纪晓军, 韩庆宝, 等. 创伤骨折手术切口愈合不良的危险因素分析[J]. 中国骨与关节损伤杂志, 2019, 34(3): 332-333. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201903046.htm
[2]	MCDEVITT J, CANCELA MDE C, KELLY M, et al. Tracheostomy and infection prolong length of stay in hospital after surgery for head and neck cancer: A population based study[J]. Oral Surg Oral Med Oralpathol Oral R Adiol, 2016, 121(1): 22-28. doi: 10.1016/j.oooo.2015.08.004
[3]	王存良, 曹东子. 老年胸腰椎骨折患者术后切口感染发生率及病原学特征[J]. 中国临床研究, 2020, 33(12): 1665-1668. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202012018.htm
[4]	许俊胜, 江淮, 孙良业, 等. 胫骨平台骨折术后切口愈合不良的影响因素[J]. 中国矫形外科杂志, 2018, 26(14): 1268-1273. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXS201814007.htm
[5]	李志浩, 胡允腾, 张福. 术后低白蛋白血症与补充人血白蛋白对腰椎内固定术后发生切口愈合不良的影响[J]. 中华医学杂志, 2020, 100(11): 848-849, 852. doi: 10.3760/cma.j.cn112137-20190613-01347
[6]	GUNDTOFT P H. Prosthetic joint infection following total hip arthroplasty-incidence, mortality and validation of the diagnosis in the Danish hip arthroplasty register[J]. Dan Med J, 2017, 64(9): B5397-B5402. http://www.ncbi.nlm.nih.gov/pubmed/28874245
[7]	PENNINGTON Z, SUNDAR S J, LUBELSKI D, et al. Cost and quality of life outcome analysis of postoperative infections after posterior lumbar decompression and fusion[J]. J Clin Neurosci, 2019, 6(8): 105-110. http://www.sciencedirect.com/science/article/pii/S0967586819307568
[8]	王仕永, 姚汝斌, 任莉荣, 等. 腰椎融合术后切口深部感染的危险因素分析[J]. 中国脊柱脊髓杂志, 2020, 30(10): 872-879. doi: 10.3969/j.issn.1004-406X.2020.10.02
[9]	SPIEGLU J, JOSTEN C, DEVITT B M, et al. Incomplete burst fractures of the thoracolumbarspine: A review of literature[J]. Eur Spine J, 2017, 26(12): 3187-3198. doi: 10.1007/s00586-017-5126-3
[10]	王存良, 曹东子. 老年胸腰椎骨折患者术后切口感染发生率及病原学特征[J]. 中国临床研究, 2020, 33(12): 1665-1668. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202012018.htm
[11]	胡海涛, 纪晓军, 韩庆宝, 等. 创伤骨折手术切口愈合不良的危险因素分析[J]. 中国骨与关节损伤杂志, 2019, 34(3): 332-333. https://www.cnki.com.cn/Article/CJFDTOTAL-GGJS201903046.htm
[12]	刘斌, 甘维, 王华富, 等. 腰椎后路融合内固定术后感染的多因素logistic回归分析[J]. 临床骨科杂志, 2020, 23(6): 788-791. doi: 10.3969/j.issn.1008-0287.2020.06.011
[13]	宇洪浩, 原泉, 王欢. 胸腰椎后路内固定术后早期切口感染的影响因素[J]. 中国医科大学学报, 2019, 48(5): 406-409. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGYK201905006.htm
[14]	WANG S Y, CAO T, WANG R Z, et al. Incidence and risk factors of de novo stress urinary incontinence after pelvic floor reconstruction: A nested case-control study[J]. Chin Med J(Engl), 2017, 130(6): 678-683. http://pdfs.semanticscholar.org/d6c4/69f61302dd9d0f984e941e16b93992495978.pdf
[15]	周孝聪, 赵学凌, 雷宇, 等. 胸腰椎后路内固定术后深部感染的研究进展[J]. 中华老年骨科与康复电子杂志, 2019, 5(1): 54-57. doi: 10.3877/cma.j.issn.2096-0263.2019.01.010
[16]	SCHWARTZ A V. Diabetes, bone and glucose-lowering agents: Clinical outcomes[J]. Diabetologia, 2017, 60(7): 1170-1179. doi: 10.1007/s00125-017-4283-6
[17]	王林峰, 张静涛, 雷涛, 等. 胸腰椎后路内固定术后伤口早期深部感染的临床分析[J]. 中华骨与关节外科杂志, 2016, 9(2): 98-102. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGJW201602002.htm
[18]	刘斌, 甘维, 王华富, 等. 腰椎后路融合内固定术后感染的多因素logistic回归分析[J]. 临床骨科杂志, 2020, 23(6): 788-791. doi: 10.3969/j.issn.1008-0287.2020.06.011
[19]	刘金石, 闫慧博, 杨昌盛, 等. 后路腰椎内固定术后手术部位感染的危险因素分析[J]. 中国脊柱脊髓杂志, 2019, 29(11): 995-1000. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJZS201911007.htm
[20]	宋建东, 陈子健, 李停, 等. 脊柱侧凸后路矫形术后伤口愈合不良诊疗分析[J]. 中国中医骨伤科杂志, 2017, 25(11): 71-72. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZG201711020.htm