摘要
目的评估手术清创或保守治疗方法在腰椎后路椎间融合术后伤口深部感染治疗中的临床疗效。方法收集从2001年1月至2005年1月收治的213例因腰椎退行性疾病而接受后路椎间融合内固定术患者的临床资料，发现7例确诊为伤15深部感染，占3.3％。采用手术清创或者延长抗生素使用时间等保守治疗，所有7例患者均得到有效治疗，康复出院。术后对其随访，时间2．5-6．4年，平均3．6年。结果6例患者行手术清创，1例使用针对性较强的敏感抗生素治疗。手术清创者在术中分别使用体积分数为2％的过氧化氢、生理盐水反复浸泡、冲洗伤口，质量浓度为0．1％的苯扎溴铵和生理盐水冲洗后明胶海绵填塞消灭死腔，严密缝合伤口。无一例患者取出内固定，有2例患者椎间融合器位置重置。术后延长抗生素静滴和口服时间，直至红细胞沉降率和血常规白细胞计数达正常后3-4d，随访期内无再次感染的病例。Oswestry残障评分显示3例患者下肢功能轻度残碍，3例中度残障，l例患者重度残障。结论腰椎椎间融合术后深部椎间隙感染没有必要取出椎间融合器，可以采用手术清创或保守治疗等方法处理。
Objective To evaluate and compare the long-term treatment outcomes of patients with infected posterior lumbar interbody fusion （PLIF） managed with surgical debridement and or prolonged antibiotic treatment without removal of the interbody cages. Methods Between January 2001 and January 2005, 7 of 213 patients underwent PLIF were diagnosed with deep wound infection （3.3%）. All these patients were treated with the surgical debridement（6 patients） or prolonged antibiotic treatment（1 patient） according to the laboratory test results and the sensitive antibiotics. All these 7 patients recovered before the discharge from the hospital. All infected patients were clinically followed for 2.5 to 6.4 years, and 3.6 years for average. Results Six patients were managed using the surgical debridement, after the wound was opened, we choose to using the 2% hydrogen solution, Sodium Chloride to clear the wound, and benzalkonium bromide, sodium chloride wash the wound and primary closure of the wound. None of the patients required removal of the instrumentation. In 2 patients, the PLIF cages were replaced. All 7 patients received prolonged intake intravenous antibiotic therapy and/or oral antibiotic administration, the sign of antibiotic discontinuous was the white cell count and blood sedimentation returned normal returned to normal level. During follow-up period, no clinical or laboratory signs of recurrent infection were evident. Four of the 7 patients reported improved clinical status compared with their perfusion status. During follow-up period, there were 3 patients with minimal disability according to the Oswestry Disability Index and 3 with moderate disability with residual leg pain. Conclusion In cases of postoperative deep wound infection after PLIF with cages, removal of the interbody implants is not necessary. Treatment is composed of prolonged antibiotic therapy guided by antimierobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2008年第9期749-753,共5页
Chinese Journal of Orthopaedics
关键词
腰椎
脊柱融合术
感染
Lumbar vertebrae
Spinal fusion
Infection
