脊柱后路固定术后近端交界区迟发性感染分析与治疗探讨

目的 :探讨脊柱后路固定术后近端交界性迟发感染的特点与处理对策。方法 :回顾性分析2010年2月至2015年10月1 325例行脊柱后路固定手术患者,发现10例迟发性感染,其中4例迟发感染发生在近端交界区而非手术部位,分别给予二联广谱抗生素抗感染治疗。对这4例患者的临床症状、体征、实验室检验、MRI、病理及治疗效果进行分析。结果:随访6个月~5年,未发现感染复发,4例患者出院时治疗效果满意,无神经损伤,1例患者2年后随访是出现交界性后凸。按腰椎术后日本N.Nakano和T.Nakano功能评定标准:优3例,差1例。结论:脊柱术后迟发感染发生率低,对脊柱后路固定术后近端交界区迟发感染病因机制可能是固定后临近节段应力集中,邻近节段退变,形成易感染区。患者脊柱后路固定术后顽固性腰背疼痛,结合血沉、C-反应蛋白增高、MRI的表现及病灶取样标本病理,则可明确诊断。足量地联合应用广谱抗生素治疗效果理想。

Analysis of delayed infection of proximal junctional zone after posterior spinal internal fixation and its treatment strategy

Objective: To explore the features and treatment strategy of delayed infection of proximal junctional zone after posterior spinal internal fixation.Methods: The clinical data of 1325 patients underwent posterior spinal internal fixation were retrospectively analyzed. Delayed infection occurred in 10 patients,among which 4 infections occurred at the proximal junction (non-operative site). And these 4 patients were treated with combined broad-spectrum antibiotics. Their clinical symptoms and signs,lab tests,MRI findings,pathology findings,and clinical effects were analyzed.Results: All four patients were followed up from 6 months to 4 years. No infection recurrence was found. All patients obtained satisfactory results after hospital discharge. No nerve injury was found. One patient developed kyphosis in the proximal junctional zone 2 years after the operation. According to the criteria of N.Nakano and T.Nakano,3 cases obtained excellent results,while 1 poor.Conclusion: The incidence rate of delayed infections was rare after spinal operation. Delayed infections occurred in proximal junctional zone may be attributed to the stress concentration of adjacent segments after fixation and the degeneration of adjacent segments,thus forming inflammation areas. For refractory lumbar and back pains, an elevated blood sedimentation rate,C-reactive protein level,MRI manifestation and focal pathology would be helpful for establishing a definite diagnosis. Full course of combined broad-spectrum antibiotics in treating the infection can lead to satisfactory clinical results.