脊柱融合内固定术后相邻节段感染的研究进展  

Research progress on adjacent segment infection after spinal fusion and internal fixation

作　　者：马潇晗 姬宇飞 孙飞龙 杨意鹏 刘大铭 雷伟 张扬 MA Xiaohan;JI Yufei;SUN Feilong;YANG Yipeng;LIU Daming;LEI Wei;ZHANG Yang(No.1 Cadet Regiment,School of Basic Medical Sciences,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Department of Orthopedics,Xijing Hospital,Air Force Medical University,Xi'an 710032,China;Graduate Affairs Office,Xi'an Medical University,Xi'an 710021,China)

机构地区：[1]空军军医大学基础医学院学员一大队,陕西西安710032 [2]空军军医大学西京医院骨科,陕西西安710032 [3]西安医学院研究生处,陕西西安710021

出　　处：《空军军医大学学报》2025年第3期412-415,F0003,共5页Journal of Air Force Medical University

基　　金：陕西省重点研发计划项目(2023YBSF-146)。

摘　　要：手术部位感染是脊柱手术术后较常见且危险的并发症,然而脊柱术后相邻节段感染(ASI)是一种非常罕见的并发症。目前,有关ASI只有少数的病例报道,其发生部位广泛,且与脊柱内固定的节段有关,颈椎、胸椎、腰椎近端和远端均可受累。目前认为ASI的发生可能与手术区的血供、机体的免疫力和内植物等的直接感染有关,但国内外尚未达成统一的标准。ASI的诊断方式多种多样,可通过基本查体、血常规检查和影像学检查对其进行基本诊断,最后通过病理学检查对其进行确诊。对于早期患者可使用敏感抗生素等进行保守治疗,可获得一定的疗效;但对于已经出现严重骨质破坏导致节段性失稳或后凸畸形,顽固性局部疼痛以及抗感染治疗或抗生素耐药性失败的患者,应根据情况尽早行前路或后路翻修清创及重建手术。本文系统地回顾了相关文献,以期为该病的预防和治疗提供相关的依据。Surgical site infection is a relatively common and dangerous complication following spinal surgery,whereas adjacent segment infection(ASI)after spinal surgery is an extremely rare complication.Currently,only a few cases of ASI have been reported,which can occur widely at various segments related to spinal internal fixation,including cervical,thoracic,proximal,and distal lumbar spine.The occurrence of ASI is believed to be possibly associated with factors such as the blood supply to the surgical area,the body s immune response,and direct infection from internal implants,but no unified standard has been established domestically or internationally.The diagnostic methods for ASI are diverse,with basic physical examination,routine blood tests,and imaging studies being used for preliminary diagnosis,followed by pathological examination for confirmation.Conservative treatment with sensitive antibiotics may achieve certain efficacy in early-stage patients;however,for those with severe segmental instability or kyphotic deformity due to significant bone destruction,stubborn local pain,or failure of antimicrobial therapy or antibiotic resistance,early anterior or posterior revision debridement and reconstruction surgery should be considered as appropriate.This article systematically reviews relevant literature in order to provide evidence for the prevention and treatment of this condition.

关 键 词：手术部位感染 相邻节段 脊柱融合术后 脊柱内固定 

分 类 号：R687.3[医药卫生—骨科学]