胸腰椎手术后切口早期深部感染的处理  

Efficacy observation of different methods for treatment of deep infection of the wound after thoracolumbar operation

作　　者：王永刚[1] 康学文[1] 王东敏[1] 张秀[1] 马佩芬[1] 王红[1] 陈宝[1] 

机构地区：[1]兰州大学第二医院骨科,甘肃兰州730030

出　　处：《临床骨科杂志》2017年第3期307-309,共3页Journal of Clinical Orthopaedics

基　　金：甘肃省青年科技基金计划(编号:1606RJYA230)

摘　　要：目的探讨胸腰椎手术后深部切口感染的处理方法。方法将41例胸腰椎内固定手术后深部切口感染患者按处理方法分成4组,A组:早期彻底清创,保留内固定装置,置管冲洗引流;B组:早期切口换药感染未控制,然后进行手术彻底清创并保留内固定,负压封闭引流(VSD);C组:早期换药感染未控制,后行彻底清创并取出内固定,置管冲洗引流;D组:早期彻底清创,取出内固定,置管冲洗引流。结果 A、D组感染治疗时间、术后神经症状明显少于B、C组(P<0.05);A、B组术后腰痛症状明显少于C、D组(P<0.05)。结论胸腰椎手术后切口早期深部感染应早期诊断,彻底清创,置管冲洗引流,结合抗生素使用有效控制感染,可避免内固定取出,维持脊柱稳定性,减少并发症发生。Objective To investigate the treatment methods of deep wound infection after thoracolumbar operation.Methods The 41 patients of deep incision infection after thoracolumbar internal fixation,according to treatment methods,were divided into 4 groups.Group A：early debridement,retained internal fixation device,catheter drainage;group B：early incisions were treated with dressing change,but the infection was not controlled,then surgical debridement and retention of internal fixation,vacuum sealing drainage （VSD）;group C：early incisions were treated with dressing change,but the infection was not controlled,then debridement and removal of internal fixation,catheter drainage;group D：early debridement,internal fixation removal,catheter drainage.Results Groups A and D infection treatment time,postoperative neurological symptoms were significantly less than group B and C （P〈0.05）.Groups A and B postoperative lumbar complications were significantly less than group C and D （P〈0.05）.Conclusions The early deep infection of incision after thoracolumbar surgery,it should be early diagnosed,complete debridement,drainage and drainage,combined with the use of antibiotics,effective control of infection,to avoid internal fixation to remove,maintain spinal stability,reduce complications.

关 键 词：胸腰椎手术 切口感染 置管冲洗引流 

分 类 号：R687.3[医药卫生—骨科学] R619.3[医药卫生—外科学]