胸腰椎后路内固定术后深部感染的治疗

目的 探讨胸腰椎后路内固定术后深部感染的特点与治疗方法。方法对36例胸腰椎内固定术后感染患者的临床表现、生化和细菌学检查及治疗进行分析。根据发生感染时间的不同分为早期感染14例,迟发性感染22例。结果早期感染一般伴有全身症状,白细胞计数及红细胞沉降率（ESR）升高,脓液培养主要为金色葡萄球菌、大肠杆菌等致病力强的细菌,迟发性感染一般无全身症状,白细胞计数不升高,ESR升高,脓液培养主要为类白喉杆菌、表皮葡萄球菌等致病菌力较弱的皮肤正常菌群。早期感染患者予以清创、持续冲洗引流。除3例反复清创无效,将内固定取出以外,其余内固定均予保留。迟发性感染者予以内固定取出、清创、持续冲洗引流。33例平均随访2．6年,经上述治疗后仅1例患者早期深部感染迁延不愈致椎体骨髓炎,术后3个月伤口再次出现流脓,其余均愈合。结论胸腰椎固定后早期感染及迟发性感染的发生机理可能存在差异。早期感染由致病力强的细菌引起,累及范围广。而迟发性感染由致病菌弱细菌引起,发展慢且较局限。对早期深部感染可以保留内固定行病灶清除,持续冲洗引流,多次清创无效,感染控制不佳则需要早日将内固定取出,以免炎症扩散。而迟发性感染则需取出内固定,否则难以消除炎症。

The treatment of deep wound infection after posterior thoracic and lumbar instrumentation

OBJECTIVE: To study the characteristics and treatment of the deep wound infection after thoracic and lumbar instrumentation. METHODS: Thirty-six cases of deep wound infection after thoracic and lumbar instrumentation were retrospectively reviewed. There were acute deep wound infection in 14 cases and delayed infection in 22 cases. The patients with acute infection were treated with debridement and continuous irrigation and suction. Internal fixators were removed in 3 cases for repeated infection. The patients with delayed infection were treated with internal fixator removal, debridement and continuous irrigation and suction. RESULTS: At follow-up evaluation, only 1 patient had recurrence of infection because of his complicating vertebral osteomyelitis. The most common organisms cultured in acute deep wound infection were staphylococcus aureus and colibacillus while staphylococcus epidermis, micrococcus and diphtheria bacillus in delayed infection. The white cell count and ESR were elevated in the acute deep wound infection while only the ESR elevated and the white cell count remained normal in the delayed deep wound infection. CONCLUSIONS: There may be different between the acute and delayed deep wound infection's pathology. The internal fixator could be remained in the acute deep wound infection which need be removed in the delayed deep wound infection.