胸腰椎体暴裂骨折合并截瘫早期内固定治疗及尿路感染控制  

Early internal fixation treatment of thoracolumbar burst fracture with paraplegia and control of urinary tract infections

作　　者：闫桂虹[1] 谢菲[1] 王虹[1] 程慧玲[1] 陈娟娟[1] 

机构地区：[1]天津市天津医院脊柱外科,天津300211

出　　处：《中华医院感染学杂志》2012年第5期931-932,共2页Chinese Journal of Nosocomiology

摘　　要：目的评价早期后路三柱固定手术治疗胸腰段椎体暴裂骨折的临床疗效及尿路感染控制策略,在预防尿路感染中的作用。方法对38例胸腰段不稳定骨折伴截瘫患者采用单纯后侧入路切除部分椎体植入钛网,并联合椎弓根螺钉内固定治疗,提供三柱固定;术后做好留置尿管的护理,有效进行尿路感染监控。结果 38例患者术后发生尿路感染6例,感染率为15.8%;女性5例,感染率为55.56%,男性1例,感染率为3.45%,男女性尿路感染率比较差异有统计学意义(P<0.01);年龄≥60岁发生尿路感染5例,感染率为45.45%;<60岁发生尿路感染1例,感染率为3.70%,差异有统计学意义(P<0.01)。结论早期行后路三柱固定治疗胸腰椎体暴裂骨折,能明显改善患者的神经损伤程度;对女性和老年患者加强护理,可降低尿路感染发生率,促进膀胱功能恢复。OBJECTIVE To evaluate the efficacy of early posterior surgical treatment of the thoracolumbar burst fractures and the effect of infection control strategy on prevention of urinary tract infection.METHODS Totally 38 patients having unstable thoracolumbar vertebrae fractures with paraplegia were treated by posterior partial vertebrae resection and titanium mesh cage bone fusion and internal fixation of pedicle screw instrumentation,three-column fixation was performed.Effective control of urinary tract infection was also performed by post-operative nursing care for catheterization.RESULTS Totally 6 patients had postoperative urinary tract infection among 38 patients;5 cases were female,accounting for 55.56% among the female participants;and 1 case was male,accounting for 3.45% among the male participants.The difference in the rate of urinary tract infections between female and male was statistically significant（P0.01）.Urinary tract infection occurred in 5 patients（45.45%） aged ≥60 years old and in 1 patient（3.70%） aged 60 years old,the difference was statistically significant（P0.01）.CONCLUSION Early posterior surgical approach of three-columns fixation can significantly improve neural injury.The nursing care for female and senile patients should be strengthened so as to reduce the rate of urinary tract infection,promote the recovery of bladder function and maximize the quality of life.

关 键 词：胸腰段 椎体骨折 截瘫 内固定 尿路感染 

分 类 号：R181.32[医药卫生—流行病学]