脊柱周围深部感染的外科治疗  

Surgical treatment of deep infection around the spine

作　　者：翟利锋[1] 马苟平[1] 刘亦杨[1] 沈立锋[1] 郭峭峰[1] 张春[1] ZHAI Li-feng;MA Gou-ping;LIU Yi-yang;SHEN Li-feng;GUO Qiao-feng;ZHANG Chun(Department of Orthopaedics,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院骨科,浙江杭州310012

出　　处：《中国骨伤》2019年第10期886-891,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨脊柱周围深部感染的外科治疗方法及临床疗效。方法:自2015年1月至2018年1月收治脊柱周围深部感染患者7例,均为脊柱术后3周内发生的急性感染。其中男5例,女2例,年龄29~67岁,平均42岁。伤口有内植物4例,无内植物3例。感染确诊后,采用负压封闭引流辅助下彻底清创,局部放置载抗生素人工骨结合全身静脉滴注抗生素,并以血供丰富的组织瓣修复创面的方法治疗。所用组织瓣包括:椎旁肌推进肌瓣4例,胸腰筋膜瓣1例,背阔肌肌瓣1例,椎旁肌推进肌瓣联合胸腰筋膜瓣1例。结果:术后7例患者均获得随访,随访时间6~24个月,平均13.28个月。随访期间,有内植物的4例患者中,除1例腰椎融合的患者因术后感染复发而拆除内固定外,其余3例成功保留内植物。1例颈椎骨折脱位患者经背阔肌转位术后感染创面愈合,但供区皮瓣下出现积液,经过穿刺引流,局部加压包扎后治愈。其余5例创面获得Ⅰ期愈合,无感染复发、血肿、积液及伤口裂开等术后并发症发生。结论:脊柱周围深部感染是一种严重并发症,一旦确诊,应积极治疗。负压封闭引流辅助下彻底清创,局部放置载抗生素人工骨结合全身静滴抗生素,并以邻近组织瓣修复创面是治疗脊柱周围深部感染的一种有效术式。Objective:To study the surgical method and clinical effect of deep infection around the spine.Methods:The clinical data of 7 patients with deep infections around the spine treated from January 2015 to January 2018 were retrospectively analyzed.All patients were acute infection within 3 weeks after spinal surgery.There were 5 males and 2 females,aged from 29 to 67 years old with an average of 42 years old.Four of them had implants and the other three didn’t.After infection was diagnosed,they accepted aggressive debridement with assistance of vacuum sealing drainage(VSD).The antibiotic artificial bones were put in wounds,combined with intravenous antibiotics.Blood-rich adjacent tissue flaps were used to reconstruct defect of wounds.The tissue flaps included 4 paraspinal muscle flaps,1 thoracolumbar fascial flap,1 latissimus dorsi flap and 1 paraspinal muscle combined with thoracolumbar fascial flap.Results:All 7 patients were followed up from 6 to 24 months with an average of 13.28 months.During the follow-up period,among the 4 patients with instrument,except one patient of lumbar fusion removed internal fixation due to postoperative infection,the other 3 patients successfully kept the implants.One case of cervical fracture and dislocation was repaired by latissimus dorsi transposition.Its wound healed but hydrops accumulated under the flap.This patient was cured by puncture drainage and local pressure bandaging.The other 5 wounds’healing were first intention and no postoperative complications such as infection recurrence,hematoma,effusion or wound dehiscence occurred.Conclusion:Deep infection around the spine is a serious complication and should be treated aggressively once diagnosed.Thorough debridement with the help of negative pressure closed drainage,local application of antibiotic artificial bone combined with systemic intravenous antibiotics and repairing wounds with adjacent tissue flaps are effective procedures for the treatment of deep infection around the spine.

关 键 词：脊柱 感染 引流术 载抗生素人工骨 筋膜瓣 肌瓣 

分 类 号：R687.3[医药卫生—骨科学]