腰椎内固定术后感染的诊治体会(附11例报告)

目的进一步探讨腰椎内固定术后感染的诊断和治疗经验。方法对2005年2月~2011年6月收治并获得随访的11例腰椎内固定椎间植骨融合术后感染患者的临床资料进行回顾性分析,腰椎间盘突出5例,腰椎滑脱6例,怀疑感染立即行实验室检查C反应蛋白（CRP）、血沉﹙ESR﹚,结合临床表现、分层穿刺等早期诊断;一旦感染确定,均立即采取伤口切开清创、持续灌注引流、尽量保留内固定的方法,并静脉应用抗生素和营养支持。结果经上述方法处理,患者临床症状短期内明显缓解;3~6周后,患者症状基本消失,实验室检查血常规、CRP、ESR降至正常水平。经6个月~2年随访,所有患者未再出现伤口深部脓肿。结论一旦怀疑感染,早期诊断并立即切开清创、持续灌注引流配合全身抗炎治疗,对腰椎内固定术后感染是一种有效的处理方法。

Diagnosis and treatment experience of infection after lumbar instrument(11 cases report)

Objective To investigate the diagnosis and treatment of infection under the lumbar spine after pedicle screw system.Method Between February 2005 and June 2011,11 patients with infection after lumbar instrument were treated and followed up.Retrospective analysis showed 6 patients suffered from lumbar disc herniation and 5 patients suffered from spondylolisthesis.C-Reactive Protein(CRP) and ESR were tested when there was infectious symptom of a trend.Clinical feature and layered puncture were also used for early diagnosis.Debridement and continue closed-sunction drainage were done as soon as infection was made sure.Internal fixtor were not be removed.Antibiotic and nutrition were used for all patients.Results After treatment,Clinical symptoms degraded in a short time and disappeared within 3 to 6 weeks.Blood routine,CRP,ESR examination reversed to mean.A followed-up of 6 months and 2 years showed signs of infection were not found for all patients.Conclusion Early diagnosis,debridement,continue closed-sunction drainage and antibiotic were critical for the infectious patients of lumbar instrument.