经皮脊柱内镜腰椎间盘摘除术后手术部位感染的临床特点及防治策略  

Clinical Characteristics and Prevention Strategies of Surgical Site Infection After Percutaneous Endoscopic Lumbar Discectomy

作　　者：陈荣彬 潘艺之 陈文创 鲁尧[1] 张劲新[1] 吴钊钿[1] 李勇[1] Chen Rongbin;Pan Yizhi;Chen Wenchuang(*Department of Orthopedics,Guangdong Provincial Hospital of Traditional Chinese Medicine Zhuhai Hospital,Zhuhai 519015,China)

机构地区：[1]广东省中医院珠海医院骨三科,珠海519015 [2]广州中医药大学第二临床医学院,广州510405

出　　处：《中国微创外科杂志》2024年第5期343-349,共7页Chinese Journal of Minimally Invasive Surgery

基　　金：珠海市社会发展领域科技计划项目(2320004000271);广东省第四批名中医师承项目(粤中医办函〔2023〕108号)。

摘　　要：目的总结经皮脊柱内镜腰椎间盘摘除(percutaneous endoscopic lumbar discectomy,PELD)术后手术部位感染(surgical site infection,SSI)的诊治经验。方法回顾性分析2016年1月~2022年12月11例PELD术后SSI的病例资料。PELD术后均出现剧烈腰背部或下肢疼痛,视觉模拟评分(Visual Analogue Scale,VAS)7~9分,平均8.1分。红细胞沉降率(ESR)17~114 mm/h,平均54.4 mm/h,C反应蛋白(CRP)8~151 mg/L,平均56.5 mg/L。MRI均提示术区椎间隙炎症信号改变。PELD术后2~17 d(平均9.5 d)确诊SSI。均采用抗生素治疗(经验性抗生素治疗4例,敏感抗生素7例),其中8例联合手术,包括经皮内镜病灶清除、置管冲洗引流4例,后路病灶清除2例,后路病灶清除联合内固定2例。结果随访14~75个月(平均36.8月)。根据改良MacNab标准,优5例,良4例,可2例。结论PELD术后SSI以发病急、再发剧烈腰背部或下肢疼痛、炎性指标升高及特征性影像学表现为临床特点,规范化的抗生素治疗辅以手术可以取得良好疗效。Objective To summarize the diagnosis and treatment experience of surgical site infection(SSI)after percutaneous endoscopic lumbar discectomy(PELD).Methods A retrospective analysis was made on 11 cases of postoperative SSI after PELD from January 2016 to December 2022.After PELD surgery,severe lower back or lower limb pain occurred in all the patients,with a Visual Analog Scale(VAS)score of 7-9(average,8.1).The erythrocyte sedimentation rate(ESR)was 17-114 mm/h(average,54.4 mm/h),and the level of C-reactive protein(CRP)was 8-151 mg/L(average,56.5 mg/L).The MRI showed changes of inflammatory signals in the intervertebral space of the surgical area.The SSI was diagnosed at 2-17 d(average,9.5 d)after PELD surgery.All the cases were treated with antibiotics(4 cases with empiric antibiotic therapy and 7 cases with sensitive antibiotic treatment),8 of which underwent combined surgery,including percutaneous endoscopic lesion removal,catheter irrigation and drainage in 4 cases,posterior lesion removal in 2 cases,and posterior lesion removal combined with internal fixation in 2 cases.Results The patients were followed up for 14-75 months(average,36.8 months).According to the modified MacNab criteria,5 cases were excellent,4 cases were good,and 2 cases were fair.Conclusions SSI after PELD is characterized by acute onset,recurrent severe lower back or lower limb pain,elevated inflammatory markers,and characteristic imaging features.Standardized antibiotic treatment combined with surgery can achieve good therapeutic effects.

关 键 词：经皮内镜腰椎间盘髓核摘除术 腰椎间盘突出症 手术部位感染 临床特点 防治策略 

分 类 号：R687.3[医药卫生—骨科学]