脊柱侧凸后路三维矫形融合术后并发迟发性深部感染

目的：评估脊柱侧弯患者后路矫形术后深部迟发性感染的发病机理，早期诊断和治疗。方法：回顾性研究自1998年8月～2002年1月共509例行后路矫形的脊柱侧凸患者，其中有5例病人发生了深部迟发性感染。对深部迟发性感染距初次手术的时间，影像学资料，血沉，假关节的发生情况，分泌物的培养和药敏结果，伤口闭合类型和抗生素的使用情况进行了分析。结果：5例患者发生了迟发性感染(0．98％)。距初次手术平均时间为19．2个月，病人都有窦道的形成，2例患者背部疼痛，仅有1例患者在窦道形成前有发热史。平均血沉55．5mm／h，无患者发生假关节，培养结果均为金黄色葡萄球菌，所有患者均行内置物去除，一期闭合伤口并最终愈合。结论：皮下脓肿和窦道形成是迟发性感染的明确的诊断依据。人体皮肤上低毒性细菌的术中种植和金属腐蚀可能是迟发性感染的主要发生机理，一期闭合能使伤口早期愈合，短期内静脉使用抗生素(7d)，然后口服抗生素(10d)是值得推荐的方法。

Delayed Deep Infections after Posterior Spinal instrumentation for Scoliosis

Objective: To evaluate the pathogenesis, early diagnosis, and treatment of the delayed deep infection after posterior spinal instrumentation for scoliosis.Method:Five hundred and nine scoliotic patients who underwent posterior instrumented correction from Aug.1998 to Jan.2002 were reviewed,5 cases of the delayed deep infections were found.Time of presentation (infection) from initial surgery, clinical picture, sedimentation rate,presence of pseudarthrosis, organism grown on culture, type of wound closure, and duration of antibiotics were studied.Results:Five patients had delayed infections(0.98%).Time of presentation averaged 19.2 months after initial surgery.Spontaneous drainage occurred in all patients, back pain occurred in 2 patients, only one patient had fever before spontaneous drainage ocurred.Sedimentation rate averaged 55.5mm/h.No patient had pseudarthrosis.Cultures grew staphylococcus aureus in all patients.All patients had instrumentation removed and primary closure.Their wound healed uneventfully. Conclusion:Subcutaneous bursa formation and spontaneous drainage are definite diagnosis of delayed infection after posterior instrumentation.Intra operative seeding of low virulent skin organisms and fretting corrosion of the metal implants might be primarily responsible for delayed infections.Primary wound closure results in successful early wound healing.Short term postoperative parenteral antibiotics(7days) followed by short-term oral antibiotics(10days) is recommended.