后入路胸腰椎结核患者术后切口愈合不良的危险因素分析：1项单中心回顾性观察队列研究

Risk factors for poor wound healing in patients undergoing posterior thoracolumbar tuberculosis surgery: A single-center retrospective observational cohort study

摘要

目的 分析胸腰椎结核患者术后切口愈合不良（poor wound healing，PWH）的风险因素。 方法 回顾性纳入重庆医科大学附属第一医院骨科2019年1月至2021年10月接受后入路胸腰椎结核病灶清除+植骨融合内固定术的124例患者，其中16例发生PWH，108例未发生PWH。根据术后是否出现PWH分为PWH组和非PWH组。对比研究2组患者术前资料，包括：性别、年龄、吸烟/饮酒史、是否合并高血压/肺结核/糖尿病、手术固定节段数、体质指数（body mass index，BMI）、平均红细胞体积（mean corpuscular volume，MCV）、平均红细胞血红蛋白含量（mean corpuscular hemoglobin，MCH）、平均红细胞血红蛋白浓度（mean corpuscular hemoglobin concentration，MCHC）、血红蛋白（hemoglobin，Hb）、血小板（platelet，PLT）、中性粒细胞计数和百分比、淋巴细胞计数和百分比、单核细胞计数和百分比、血红蛋白、前白蛋白、白蛋白、红细胞沉降率（erythrocyte sedimentation rate，ESR）和C反应蛋白（C-reactive protein，CRP）。采用单变量分析、多因素二元逻辑回归及受试者工作特征（receiver operating characteristic，ROC）曲线分析探讨影响因素。 结果 单变量分析结果发现：合并肺结核（χ²=5.458，P=0.019）、手术固定节段数（Z=-3.407，P=0.001）、PLT（Z=-2.766，P=0.006）、MCV（Z=2.957，P=0.004）、MCH（Z=-3.001，P=0.003）、MCHC（Z=2.379，P=0.019）、中性粒细胞绝对值（Z=-3.723，P<0.001）、中性粒细胞百分比（Z=-3.678，P<0.001）、淋巴细胞百分比（Z=3.798，P<0.001）、Hb（Z=-3.225，P=0.001）、前白蛋白（Z=3.988，P<0.001）、白蛋白（Z=-3.562，P<0.001）、ESR（Z=-2.971，P=0.003）、CRP（Z=-4.305，P<0.001）为明显危险因素。经多因素二元logistic回归分析得出：手术固定节段数、术前中性粒细胞百分比、术前中性粒细胞绝对值、术前淋巴细胞百分比和CRP为胸腰椎结核患者术后PWH的独立危险因素。ROC曲线分析显示，手术固定节段数、术前中性粒细胞百分比、术前中性粒细胞绝对值、术前淋巴细胞百分比和 CRP最佳临界值分别为5个节段、71.5%、5.29×10⁹/L、19.45%和40.95 mg/L。 结论 缩短切口长度以减少手术创伤，术前监测中性粒细胞、淋巴细胞以及CRP水平，可减少胸腰椎结核患者术后发生PWH的风险。

Abstract

Objective To investigate the risk factors for poor wound healing（PWH） in patients undergoing thoracolumbar tuberculosis surgery. Methods A retrospective analysis was performed for 124 patients who underwent posterior thoracolumbar tuberculosis debridement，bone graft fusion，and internal fixation in Department of Orthopedics，The First Affiliated Hospital of Chongqing Medical University from January 2019 to October 2021，among whom there were 16 patients with PWH and 108 patients without PWH. According to the presence or absence of PWH after surgery，they were divided into PWH group and non-PWH group. The two groups were compared in terms of preoperative data，including sex，age，smoking/drinking history，comorbidity of hypertension/pulmonary tuberculosis/diabetes，number of surgically fixed segments，body mass index，mean corpuscular volume（MCV），mean corpuscular hemoglobin（MCH），mean corpuscular hemoglobin concentration（MCHC），hemoglobin（Hb），platelet count（PLT），neutrophil count and percentage，lymphocyte count and percentage，monocyte count and percentage，prealbumin，albumin，erythrocyte sedimentation rate（ESR），and C-reactive protein（CRP）. The univariate analysis，the multivariate binary logistic regression analysis，and the receiver operating characteristic（ROC） curve analysis were used to investigate related influencing factors. Results The univariate analysis showed that pulmonary tuberculosis（χ² =5.458，P=0.019），number of surgically fixed segments（Z=-3.407，P=0.001），PLT（Z=-2.766，P=0.006），MCV（Z=2.957，P=0.004），MCH（Z=-3.001，P=0.003），MCHC（Z=2.379，P=0.019），absolute neutrophil count（Z=-3.723，P<0.001），percentage of neutrophils（Z=-3.678，P<0.001），lymphocyte percentage（Z=3.798，P<0.001），Hb（Z=-3.225，P=0.001），prealbumin（Z=3.988，P<0.001），albumin（Z=-3.562，P<0.001），ESR（Z=-2.971，P=0.003），and CRP（Z=-4.305，P<0.001） were significant risk factors. The multivariate binary logistic regression analysis showed that the number of surgically fixed segments，preoperative percentage of neutrophils，preoperative absolute neutrophil count，preoperative lymphocyte percentage，and CRP were independent risk factors for postoperative PWH in patients with thoracolumbar tuberculosis. The ROC curve analysis showed that the cut-off values of the number of surgically fixed segments，preoperative percentage of neutrophils，preoperative absolute neutrophil count，preoperative lymphocyte percentage，and CRP were 5 segments，71.5%，5.29×10⁹/L，19.45%，and 40.95 mg/L，respectively. Conclusion Incision length can be shortened to reduce surgical trauma，and preoperative monitoring of neutrophils，lymphocytes，and CRP can reduce the risk of PWH in patients after thoracolumbar tuberculosis surgery.

关键词

切口愈合不良 / 危险因素分析 / 脊柱结核 / 受试者工作特征曲线 / 外科手术 / logistic回归

Key words

poor wound healing / risk factor analysis / spinal tuberculosis / receiver operating characteristic curve / surgical operation / logistic regression

基金资助

国家自然科学基金资助项目(82172682;82373221)

重庆市自然科学基金资助项目(CSTB2023NSCQ-MSX0472)