保留内固定植入物治疗胸腰椎术后感染  

Treatment for thoracolumbar spine infection without removing internal fixation

作　　者：林旭[1] 谭伦[1] 曾俊[1] 吴超[1] 丁勇[1] 郭勇[1] 

机构地区：[1]自贡市第四人民医院骨科,四川省自贡市643000

出　　处：《中国组织工程研究》2015年第4期537-542,共6页Chinese Journal of Tissue Engineering Research

摘　　要：背景:胸腰椎内固定后感染临床上并不罕见,一旦发生后果十分严重。在治疗感染时,是否取出内固定还存在争议。目的:探讨保留内固定治疗胸腰椎术后感染的安全性。方法:2008年3月至2012年12月自贡市第四人民医院骨科共进行胸腰椎内固定手术358例,术后发生早期和晚期感染共13例,男5例,女8例;平均年龄54.5岁(31-65岁)。患者经过积极清创、引流和抗感染治疗,观察治疗后伤口愈合情况,并对比分析清创引流术前、术后6个月的血液分析结果、血沉、C-反应蛋白和目测类比评分结果。结果与结论:13例患者感染发生时间为内固定后1-13个月。经过及时诊断和彻底的病灶清除、冲洗引流、抗感染治疗,除对1例内固定后5个月感染的T12骨折患者取出内固定物外,其余12例患者在保留内固定的情况下治愈感染。随访时间8-40个月,无复发病例。清创引流术前与术后6个月血液分析结果、血沉、C-反应蛋白和腰痛目测类比评分比较,差异有显著性意义(P<0.05)。提示胸腰椎内固定后感染后应及时明确诊断,尽早手术治疗。经过彻底的病灶清除、冲洗引流和抗感染治疗,多数患者可以很快缓解症状,保留内固定的情况下,治愈感染。BACKGROUND：Surgical site infection of instrumented thoracolumbar spine is not rare and may induce serious consequences. There’s controversy about whether to remove the internal fixation in the treatment of infection. OBJECTIVE： To evaluate the safety of the treatment for surgical site infection of thoracolumbar spine without removing internal fixation. METHODS：A total of 358 patients underwent thoracolumbar internal fixation in Department of Orthopedics, the Fourth People’s Hospital of Zigong City, between March 2008 and December 2012. Among them, 13 cases appeared surgical site infection of instrumented thoracolumbar spine, including 5 males and 8 females. The average age of the 13 cases was 54.5 years （31-65 years）. After patients were treated with aggressive debridement, irrigation and anti-infective therapy, the wound healings were evaluated. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score were analyzed and compared before debridement and 6 months after debridement. RESULTS AND CONCLUSION： The 13 patients had surgical site infection of instrumented thoracolumbar spine during 1 to 13 months post-operation. After timely diagnosis, aggressive debridement and irrigation, as wel as sensitive antibiotic therapy, 12 patients succeeded in curing infection and retaining implants. 1 patient with T12 fracture removed the fixation and cured infection. The folow-up time was 8-40 months, no case recurred. The＆nbsp;hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score showed significant difference before debridement and 6 months after debridement （P 〈 0.05）. Postoperative infection after thoracolumbar internal fixation should be timely diagnosis and receive surgical treatment. Through aggressive debridement, irrigation and sensitive antibiotic therapy, most patients can be cured without removing internal fixation.

关 键 词：植入物 脊柱植入物 感染 胸腰椎 内固定 清创引流 C-反应蛋白 血沉 目测类比评分 

分 类 号：R318[医药卫生—生物医学工程]