胸腰椎骨折后路固定术后切口愈合不良的因素

Factors related to poor incision healing after posterior pedicle screw fixation of thoracolumbar fractures

摘要:

[目的] 探讨胸腰椎骨折后路固定术后切口愈合不良的危险因素。[方法] 本院2017 年6 月—2022 年9 月后路椎弓钉固定胸腰椎骨折的146 例患者纳入本研究，依据切口愈合情况分为切口愈合不良组和切口愈合良好组，采用单因素比较和多因素逻辑回归分析探索切口愈合不良的危险因素。[结果] 146 例患者中，切口愈合不良21 例，占比14.4%。切口愈合不良组患者年龄[(47.8±8.1) 岁vs (41.3±11.2) 岁, P=0.003]、BMI [(26.0±5.3) kg/m2 vs (21.1±3.4) kg/m2, P＜0.001]、糖尿病患病史[(11/10) 例vs (10/115) 例, P＜0.001]、手术时间[(91.9±17.9) min vs (77.7±16.5) min, P＜0.001] 均显著高于切口愈合良好组，使用后路开放内固定和单纯微创内固定比率[固定/开放减压固定/微创固定, (4/9/8) 例vs (76/18/31) 例, P＜0.001] 显著高于切口愈合良好组。多因素逻辑回归分析显示，合并糖尿病（OR=4.017, P=0.030），BMI（OR=1.178, P=0.009）、手术时间（OR=1.036, P=0.040） 是胸腰椎骨折术后切口愈合不良的独立危险因素。[结论] 手术时间、肥胖、糖尿病是手术切口愈合不良的主要因素。

Abstract:

[Objective] To explore the risk factors of poor incision healing after posterior pedicle screw fixation of thoracolumbar frac-tures. [Method] A total of 146 patients were included in this study, who underwent posterior pedicle screw fixation of thoracolumbar frac-tures in our hospital From June 2017 to September 2022. The patients were divided into two groups based on the condition of incision heal-ing: the poor incision healing group (PIH) and the good incision healing group (GIH). Univariate comparison and multivariate logistic regres-sion analysis were used to explore the risk factors for PIH. [Results] Among146 patients who underwent surgical treatment, 21 had PIH, ac-counting for 14.4%. As results of univariate comparisons, the PIH groups proved significantly greater than the GIH group in terms of age[(47.8±8.1) years vs (41.3±11.2) years, P=0.003], BMI [(26.0±5.3) kg/m2 vs (21.1±3.4) kg/m2, P＜0.001], history of diabetes [yes/no, (11/10)vs (10/115) , P＜0.001], operation time [(91.9±17.9) min vs (77.7±16.5) min, P＜0.001], and the ratio of posterior internal fixation and simpleminimally invasive internal fixation [fixation / open decompression fixation / minimally invasive fixation, (4/9/8) vs (76/18/31), P＜0.001].The multivariate logistic regression analysis showed that diabetes (OR=4.017, P=0.030), BMI (OR=1.178, P=0.009), and operation time(OR=1.036, P=0.040) were independent risk factors for poor wound healing after posterior pedicle screw fixation of thoracolumbar fractures.[Conclusion] The longer operation time, greater BMI and diabetes are the main factors related to poor wound healing after posterior pedi-cle screw fixation of thoracolumbar fractures.