腰椎术后化脓性感染的早期治疗

目的：探讨腰椎疾患术后化脓性感染的病因、诊断和早期治疗方法。方法：对2009年3月至2012年3月收治的7例腰椎术后化脓性感染患者进行回顾性分析，男6例，女1例；年龄42-62岁，平均46．5岁。其中合并椎管内感染并-侧肢体短暂瘫痪1例，其余为椎管外化脓性感染。均给予早期手术干预，术中采用持续低压脉冲生理盐水灌洗引流，术后行抗感染治疗。抗生素应用时间为4-6周，停药指征是血沉和C-反应蛋白完全正常，合并颅内化脓性感染者则必须脑脊液生化和常规检查结果完全正常。结果：7例患者均痊愈出院，住院时间2—3个月，出院时无任何神经系统残余症状。结论：腰椎术后化脓性感染-旦发生就属于骨科急重症，容易误诊，必须早期诊断。早期手术清创引流是挽救患者生命的惟-措施，而持续低压脉冲冲洗可以很好的清除深部组织间隙的残存感染灶，果断去除内固定可以一次性确保腰椎术后化脓性感染的根本控制。

Early treatment of postoperative pyogenic infection in patients with lumbar disc diseases

Objective: To explore the etiopathogenisis,diagnosis and early treatment of postoperative pyogenic infection in patients with lumbar disc diseases. Methods: From March 2009 to March 2012,7 patients with postoperative pyogenic infection were retrospectivly analyzed. There were 6 males and 1 female,ranging in age from 42 to 62 years old,with an average of 46.5 years old. Among 7 cases,outside the spinal canal suppurative infection occurred in 6 cases and inside the spinal canal infection in 1 case and with temporary paralysis. All the patients were treated with continuous saline lavage-drainage of low pressure impulse during operation. Unitive sensitive antibiotics were applied for 4-6 weeks after operation until CRP and ESR completely normal or the biochemistry and routine examination of the cerebrospinal fluid completely normal for the patients with intracranial pyogenic infection. Results: All the 7 cases obtained recovery and the length of stay was for 2-3 months. No remnant symptoms of nervous system were found at the leave hospital. Conclusion: Postoperative pyogenic infection in patients with lumbar disc diseases is an emergency,and easily results in misdiagnosis in clinic. So the early diagnosis is very important. Early debridement is the only measure to retrieve the life of patient,continuous saline lavage-drainage of low pressure impulse may remove the remnant focus of the deep soft tissue space,and removel of the internal fixation can ensure the postoperative pyogenic infection completely control.