腰椎术后切口积液的探讨  

Study of postoperative incisal effusion following posterior lumbar spinal surgery

作　　者：胡飞[1] 尚希福[1] 孔荣[1] 方诗元[1] 童元[1] 

机构地区：[1]安徽医科大学附属安徽省立医院骨科,合肥230001

出　　处：《中国矫形外科杂志》2006年第22期1716-1718,共3页Orthopedic Journal of China

摘　　要：[目的]分析后侧入路腰椎术后切口积液产生的原因，探讨积液的分型并确定相应的治疗策略。[方法]白2001年6月～2006年6月本院共开展1986例经后侧入路的腰椎手术。使用内固定的手术877例，未使用内固定手术1109例，比较两组间切口积液的发生率。将发生积液的病人分为Ⅲ型：Ⅰ型：病因明确型，共28例；Ⅱ型：感染型，共11例；Ⅲ型：病因不明确型，共14例。Ⅰ型病人给予穿刺抽液，对因治疗，营养疗法。Ⅱ型病人给予穿刺抽液，清创，手术灌洗和按药敏给予抗生菌治疗。Ⅲ型病人给予穿刺和预防应用抗生素。[结果]使用内固定组的切口积液率（4．33％）高于未使用内固定组（1．35％）P〈0．01。平均住院日：Ⅰ型14．7d，Ⅱ型：87．6d。Ⅲ型：15．6d。[结论]伴随手术过程的复杂化切口积液率明显增高。给积液分型有助于确定有效的治疗方案。Ⅰ型病人予以穿刺抽液和对因治疗。Ⅲ型治疗的关键是防止转化为Ⅱ型。Ⅱ型治疗比较困难，积极的手术干预和按药敏给予抗生菌是两个关键的治疗方法。[ Objective] To analyze the causes for postoperative ineisal effusein following posterior lumbar spinal surgery, to study a protocl for classification of effusion and afford according treatments. [ Method ] 1186 cases of posterior lumbar spinal surgery were completed in the hospital from june 2001 to june 2005,877 operations with instrumentation, 1109 oprations with non-instrumentation, to compare the rate of incisal effusion between the two groups. The patients of incisal effusion were divided into three types：Type Ⅰ ：the causes are ascertained, 28 cases： Type Ⅱ ： infection, 11 cases; Type m ：the causes are uncertain, 14 cases o Patients of type Ⅰ were received puncturation, etiological treatment, nutrient therapy. Patients of type Ⅱ were received invisal drainaga,debridement, surgical irrigation and culture-directed antibiotic. Patients of type m were received puncturation, and prophylactic antibiotics. [ Result ] The occurrences of incisal effuson were higher in instrumental group （4.33 % ）thannon-instrumental group（ 1.35% ） ,P 〈0.01. mean hospitalization time： type Ⅰ , 14.7 days;type II ,87.6 days;type II1, 15.6 days. [ Conclusion] The incidence of incisal effuscion increased with the complexity of the operatvie procedure. The classification is attributed to a protocal for effective treatments. The patients of type Ⅰ can be afforded puncturation and etiological treatment. To prevent type Ⅲ turning into type Ⅱ is a critical management for typeⅢ patients. There are more troubles in curing type Ⅱ patients. Aggressive operations and culture-directed antibiotic may be two critical treatments.

关 键 词：腰椎手术 术后并发症 切口积液 感染 

分 类 号：R687.3[医药卫生—骨科学]