抗生素骨水泥间隔治疗脊柱内固定手术深部感染的疗效分析  

Antibiotic bone cement spacer in the treatment of deep wound infection after spinal internal fixation

作　　者：蔡晓敏 余专一 李浩 聂小羊 顾佳龙 袁亚南 周江军 谢肇 赵敏 CAI Xiaomin;YU Zhuanyi;LI Hao;NIE Xiaoyang;GU Jialong;YUAN Yanan;ZHOU Jiangjun;XIE Zhao;ZHAO Min(Department of Orthopedics,the 908th Hospital of Chinese People's Liberation Army Joint Logistic Support Force,Nanchang 330000,Jiangxi,China;Department of Orthopedics,Yingtan People's Hospital,Yingtan 335000,Jiangxi,China;Department of Orthopedics,Southwest Hospital Affiliated to Army Military Medical University,Chongqing 400000,China)

机构地区：[1]解放军联勤保障部队第九〇八医院骨科,南昌330000 [2]鹰潭市人民医院骨科,鹰潭335000 [3]陆军军医大学附属西南医院骨科,重庆400000

出　　处：《医学研究与战创伤救治》2024年第9期967-971,共5页Journal of Medical Research & Combat Trauma Care

摘　　要：目的观察抗生素骨水泥间隔治疗脊柱内固定术后感染的临床疗效。方法选取2015年3月至2023年12月解放军联勤保障部队第九〇八医院骨科收治的25例脊柱内固定术后深部切口感染患者。分为骨水泥组(彻底清创后植入抗生素骨水泥者,n=10)、非骨水泥组(未使用抗生素骨水泥,n=15)。比较两组患者清创次数、伤口愈合情况、36项简明健康状况调查(SF-36)评分,及内固定保留情况。结果骨水泥组均行一次性清创+抗生素骨水泥间隔旷置,感染均被根治,其中2例取出内固定,其余8例保留;9例伤口均于清创2周内愈合,1例因骨水泥间隔外露无法愈合,二次手术取出后愈合。非骨水泥组有8例行一次性清创后治愈,其余7例需多次清创;其中5例取出内固定,其余10例保留。骨水泥组末次随访躯体健康评分及心理健康评分明显高于非骨水泥组(P<0.05)。结论抗生素骨水泥间隔是治疗脊柱内固定术后深部切口感染的有效方法,在减少死腔的同时,也实现了局部靶向给药的目的。Objective This study was aimed to observe the clinical efficacy of antibiotic bone cement in the treatment of infection after spinal internal fixation.Methods A retrospective analysis was made of the 25 patients with infection after spinal internal fixation who had been treated at our hospital from March 2015 to December 2023.Antibiotic bone cement was implanted after radicaldebridement in 10 of them(cement group),but was not in 15 of them(no-cement group).The times of debridement,wound healing,36 concise health status survey(SF-36)scores and internal fixation retention were compared.Results The infection was cured in the cement group with one-time debridement.Internal fixation was removed in 2 cases and retained in the other 8 cases.The wounds of 9 cases healed within 2 weeks after debridement,and 1 case could not heal because of exposure of bone cement spacer and healed after the operation of removing bone cement.In the no-cement group,8 cases were cured after one-time debridement,and the other 7 cases needed multiple debridement.Internal fixation was removed in 5 cases and retained in the other 10 cases.In the last follow-up Physical Component Score(PCS)and the Mental Component Score(MCS)of the cement group were higher than that of the no-cement group(P<0.05).Conclusion Antibiotic bone cement exclusion is an effective method for the treatment of wound infection after spinal internal fixation.It not only reduces the dead space,but also achieves the purpose of local targeted drug delivery.

关 键 词：脊柱内固定 抗生素骨水泥 手术部位感染 聚甲基丙烯酸甲酯 

分 类 号：R681.5[医药卫生—骨科学]