负压封闭引流复合灌洗技术在腰椎间隙及深部软组织感染治疗中的应用效果研究

背景　基于新型生物材料构建的负压封闭敷料及引流技术给椎间隙感染及其相关严重并发症的防治带来了新的希望，是目前国内外处理深部软组织包括骨组织感染的新进展。目的　观察负压封闭引流（VSD）复合灌洗技术应用于腰背深部软组织感染及腰椎后路内固定术后感染患者的治疗效果。方法　选取2012年1月—2017年1月武汉大学人民医院骨科收治的各类腰椎深部软组织感染患者21例，其均应用VSD复合灌洗技术治疗。患者均根据细菌培养结果给予敏感抗生素全程治疗，尽早实施彻底清创，创腔植入引流灌洗管附加VSD装置，根据创腔修复程度、感染指标转阴及引流液细菌培养转阴等情况，决定更换或撤除VSD装置，直至感染治疗结束、创口愈合。结果　21例患者持续冲洗引流11~27 d，平均（17.2±1.3）d；C反应蛋白（CRP）转阴时间为（15.6±1.7）d，红细胞沉降率（ESR）转阴时间为（34.3±2.4）d，疗程时长为（22.6±3.1）d。患者治疗后创口全部愈合。通过门诊随访6~48个月，未见感染复发病例。结论　VSD复合灌洗技术是治疗腰椎间盘及腰背深部软组织感染的有效治疗方式。

VSD-based Closed Irrigation Technique Applied in the Treatment of Infections Involving Lumbar Intervertebral Disc Space and Lumbar Deep Soft Tissues

Background　Sealed negative pressure sealing dressing and drainage techniques developed using new biomaterials bring new hope to the prevention and treatment of intervertebral space infection and its related serious complications.It is a new progress in the treatment of deep soft tissue infection including bone tissue infection at home and abroad.Objective　To investigate the medical efficacy of VSD-based closed irrigation technique in the treatment of infections of lumbar deep soft tissues and infections after posterior lumbar interbody fusion with internal fixation.Methods　A retrospective study was conducted with 21 patients suffering from infections of lumbar deep soft tissues from Department of Orthopedics，Renmin Hospital of Wuhan University from January 2012 to January 2017.All patient subjects were initially treated with sensitivity antibiotics based on the results of microorganism culture，and early exhaustive debridement before implantation with VSD-based closed irrigation system.The replacement or removal of VSD irrigation and drainage system was determined by the conditions including repair outcome of infected soft tissue，negative conversion of infectious markers and outcome of germiculture result after treatments which lasted till infections were cured and wounds were healed.Results　The VSD drainage systems were removed after an average of（17.2±1.3） days（range:11-27 days） of treatment.The levels of CRP and ESR decreased to normal levels after an average of（15.6±1.7） and of（34.3±2.4） days，respectively.The average hospital stay was（22.6±3.1） days with all the infections being cured completely.There was no recurrence of infection at the 6-48 months follow-up.Conclusion　VSD-based closed irrigation technique emerged as an effective treatment for infections involving lumbar intervertebral disc space and lumbar deep soft tissues.