清创加碘伏冲洗对降低胸腰椎后路手术感染率的前瞻性研究  

A prospective study of decreasing surgical site infections following posterior thoracolumbar spine surgery by debridement and Polyvidone iodine rinsing

作　　者：张军军[1] 郭昭庆[2] 卢占斌[1] 王立功[1] 陈先[1] 黄玉国[1] 刘兰泽[1] 李永民[1] 

机构地区：[1]唐山市第二医院脊柱外科,河北063000 [2]北京大学第三医院骨科

出　　处：《中国骨与关节损伤杂志》2015年第3期247-249,共3页Chinese Journal of Bone and Joint Injury

基　　金：2014年度唐山市科技计划自筹经费项目(14130239a)

摘　　要：目的探讨手术部位清创加碘伏盐水冲洗对降低胸腰椎后路手术感染的作用。方法对自2010-01—2012-06诊治的胸腰椎骨折、椎管狭窄等需要实施后路减压植骨融合内固定的患者360例随机分组,比较术后感染发生率。手术部位生理盐水冲洗组（A组）,碘伏冲洗组（B组）,清创盐水冲洗组（C组）,清创碘伏冲洗组（D组）。结果 4组均成功手术。共15例发生术后感染,其中A组8例,B组5例,C组2例,D组0例。早期感染A组6例,B组4例,C组0例,D组0例。2例感染通过应用敏感抗生素控制良好,其余行手术清创病灶清除、灌洗引流术,术后应用敏感抗生素6~8周。3例发生再感染,再次清创灌洗并取出内固定。358例获得随访10~18个月,平均14个月。A、D组感染率比较差异有统计学意义（P〈0.01）。结论采用手术部位清创加碘伏冲洗对预防胸腰椎后路手术感染效果确切,值得推广应用。Objective To investigate the effect of preventing surgical site infections（SSI） in posterior thoraco-lumbar spine surgical procedures by debridement and Polyvidone iodine rinsing. Methods From Jan. 2010 to Jun. 2012, 360 cases of thoraco-lumbar fractures or stenosis who needed posterior fusions, decompressions and internal fixations were chosen from our spine surgery department. Surgical site infection＇ ratio was compared. All the patients were divided into 4 groups at random：Normal saline（NS） rinsing（group A）; Polyvidone iodine rinsing（group B）; Debridement and（NS） rinsing（group C）;Debridement and Polyvidone iodine rinsing（group D）. Results All patients underwent successfully surgery. Fifteen cases got postoperative surgical site infection, among which 8 came from group A, 5 from group B, 2 from group C, no infection happened in group D. Early infections happened, 6 in group A, 4 in group B, none in group C or group D. Two infections were effectively controlled by sensitive antibiotics for 6 weeks. Other infections received debridement and continuous irrigation and suction. Sensitive antibiotics were used for 6-8 weeks. Three internal fixators were removed for repeated infection. Three hundred and fifty eight patients were followed up for mean 14 months（from 10 to 18 months）. All cases were successfully operated. In the infection rate there was significant difference between group A and group D（ P 0.01）. Conclusion The debridement and Polyvidone iodine rinsing are ideal methods to decrease surgical site infections following thoraco-lumbar spine posterior procedures.

关 键 词：清创 手术 胸腰椎 感染 

分 类 号：R472[医药卫生—护理学]