脊柱侧凸后路矫形融合术术后感染的治疗

目的评价清创术后置管冲洗、负压吸引及一期关闭伤口对脊柱侧凸后路矫形融合术术后感染的治疗效果。方法回顾1984年2月～1997年10月924例行脊柱后路矫形融合术的脊柱侧凸病例,发现感染15例,男5例,女10例,年龄11～32岁,平均17.5岁;特发性脊柱侧凸7例,先天性脊柱侧凸8例;内固定系统包括Harrington Luque3例,Harrington8例,CD4例。结果7例诊断为术后早期感染,平均发现时间为术后15d,清创术后除2例内固定物取出外,其余5例均予保留。8例迟发感染,平均发现时间为术后5.5个月,所有病例均予彻底清创,4例内固定物完全取出(其中1例因并发呼吸功能衰竭死亡),2例内固定物部分取出,2例保留。所有病例清创术后均置管持续冲洗及负压吸引,一期关闭伤口。平均置管冲洗2.8周,清创术后静脉使用抗生素19d。14例患者平均随访3.5年,未见感染复发。结论清创术后置管冲洗、负压吸引及一期关闭伤口,是治疗脊柱侧凸后路矫形融合术术后感染的有效方法。保留植入物,对多数病例并不影响对感染的控制。

Management of postoperative wound infection after posterior spinal fusion with instrumentation in scoliosis

Objective To evaluate the result of irrigation suction drainage system after debridement in the treatment of postoperative wound infection after posterior spinal fusion with instrumentation in scoliosis. Methods A retrospective study was carried out to review the scoliosis cases with wound infection after posterior spinal fusion with instrumentation from February 1984 to October 1997. Of the 924 cases, 15 cases had wound infection (Male, 5 cases; Female, 10 cases) with an average age of 17.5 years (range, 11-32 years). Instrumentation included Harrington (8 cases), Harrington Luque (3 cases) and CD (4 cases). Results Of the 15 cases, 7 cases were early infection which was found 15 days after surgery (range, 3-40 days), 8 cases were late infection found 5.5 months after surgery (range, 3-8 months). Implants removal was performed in 2 cases with early infection and 4 cases with late infection. Partial implant removal (compression rods removal only) was carried out in 2 cases with late infection. All the cases were treated with debridement and irrigation suction system was inserted after primary wound closure. The average irrigation time was 2.8 weeks after surgery, ranging from 2 to 4 weeks. Parenteral antibiotics was administrated within a period of 19 days (range, 10-34 days). All the wound healed uneventfully except 2 cases which needed a second debridement, and one of the 2 cases died of failure of respiratory function. At an average follow up of 3.5 years (range, 2-7.5 years), no infection recurrence was found. Conclusion Primary wound closure with irrigation suction drainage after debridement is an effective device in the treatment of wound infection after posterior spinal fusion with instrumentation in scoliosis. Maintaining the instrumentation in place was possible in most cases.