腰椎内固定术后感染的临床研究  

Clinical research of lumbar spinal internal fixation infection

作　　者：闫廷飞[1] 孙晨曦[1] 杨勇[1] 贾连顺[1] 史建刚[1] 史国栋[1] 

机构地区：[1]第二军医大学附属长征医院骨科,上海200003

出　　处：《中华骨科杂志》2016年第22期1463-1468,共6页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81371252）

摘　　要：腰椎固定术后感染是脊柱外科术后常见及严重的并发症。如果感染得不到及时合理的诊治，多致病情恶化，严重影响患者的康复和预后甚至危及生命。近年来，随着脊柱内固定融合手术的开展和普及，腰椎内固定的应用逐年增加，内固定的术后感染已经成为了脊柱外科医生不容忽视的重大并发症。内固定术后感染多是宿主、内植物和致病菌三者之间相互作用的结果。宿主抵抗力下降，内植物及致病菌的相互作用是造成内固定术后感染无法完全避免的主要因素。根据感染出现时间，临床将腰椎内固定术后感染分为早期感染、中期感染和晚期感染。根据感染波及的深浅不同，感染也可分为浅部感染和深部感染。术前准备不充分，手术操作不规范及术后护理不及时等因素则进一步增加了感染的风险。目前，关于腰椎内固定术后感染的治疗仍有部分争议。对腰椎内固定术后感染有充足的认识并时刻保持较高的警惕是降低术后感染的关键。尤其对于感染的诊断、抗生素的应用、清创引流的时机及愈合的判断尚缺乏统一的可供参考的标准。本文通过对腰椎内固定术后感染的发生机制、影响感染发生的因素、感染后的治疗进展及存在的问题等方面作一综述，以期在及时识别、合理预防和有效治疗腰椎内固定术后感染提供一定的借鉴。Postoperative infection is a common and sever complication in lumbar spinal internal fixation surgery. If the infection can＇t be treated properly, patient＇s condition will get worse and may severally influence their prognosis and even lead to death. In recent years, postoperative infection has became a sever complication which can＇t be ignored by spinal surgeon for the popularization of spinal fusion with internal fixation and increasing application of spinal internal fixation. The infection after internal fixation usually need interaction among patient, internal implant and pathogenic bacterium. The decline of patient＇s immunity combined with mutual effect between internal plant and pathogenic bacterium is the main cause of the avoidless infection after surgery. According to the time of infection, the infection can be divided into early infection, middle infection and late infection. According to the different depth of infection, the infection can be divided into superficial infection and deep infection. In sufficient preparation before surgery, nonstandard operation sequence during surgery and the absence of timely nurse after surgery can also increase the risk of infection. Sufficient understanding and keeping high vigilance against time is the key to reduce postoperative infection of this complication. At present, the treatment for postoperative infection after lumbar spinal internal fixation is still partially controversial. Especially in diagnosis of infection, application of antibiotics, timing for ebridement drainage and judgment of the healing are still lack of unified reference standard. This paper is to summarize the occurrence mechanism of postoperative infection after lumbar spinal internal fixation, influencing factors of infection, treatment progress and other issues still need to be conquered. We aim to provide certain reference in timely recognition, reasonable prevention, effective treatment of postoperative infection after lumbar spinal internal fixation surgery.

关 键 词：内固定术后感染 腰椎固定 临床研究 脊柱内固定 术前准备不充分 宿主抵抗力 有效治疗 相互作用 

分 类 号：R687.3[医药卫生—骨科学]