腰椎内固定术后深部感染的原因分析及外科处理

目的：探讨腰椎内固定术后切口深部感染的原因和外科处理措施，并观察其疗效。方法：本院2009年1月～2011年1月，我院共行腰椎椎弓根内固定、腰椎融合术治疗各类腰椎疾病1774例，其中19例患者术后发生切口深部感染，男9例，女10例。年龄12—71岁，平均54．7岁。外伤7例，腰椎管狭窄5例，腰椎间盘突出症4例，滑脱3例。其中7例合并2型糖尿病，3例术前贫血（血红蛋白〈9g／dl），3例合并四肢开放伤。对其临床资料进行回顾性分析。所有患者均行切口分泌物细菌培养，并行扩创，持续灌注冲洗引流术，对于引流液涂片阴性或者细菌培养阴性者，给予保留内固定。而行影像学检查发现内固定松动、存在引流液涂片阳性者，或者是迟发感染者则术中应去除内固定。椎间内固定物，若非存在明显的松动，感染迹象，我们不建议去除，以防感染的扩散。术后根据药敏实验结果，应用抗生素治疗。结果：本组19例切口深部感染患者，术后均获得治愈，腰痛症状明显好转，无1例发生神经症状的加重。再次术后6月复查时均获得骨性融合。所有患者腰部无明显活动受限。随访期间无1例感染复发。结论：腰椎融合内固定术后切口深部感染是一种严重的并发症，应早发现、早处理。重视术前合并病的处理，根据药敏结果使用抗生素，彻底清创，持续灌注引流术能够获得很好的临床效果。为了彻底的清创，必要时可以牺牲脊柱的即刻稳定性。

Management and reasons analysis of deep wound infection after lumbar spinal operation

Objective： To explore the management and reasons of deep wound infection after lumbar spinal operation and to access the outcome. Methods： From Jan. 2009 to Jan. 2011, 1774 patients with lumbar disease underwent lumbar vertebral internal fixation and spinal fusion, 19 （9 male and 10 female, aging 12- 71 years） of them bad deep wound infection after operation. Among them, surgical trauma in 7, lumbar spinal stenosis in 5, lumbar intervertebral disc protrusion in 4 and slippage in 3 cases. Combined with type 11 diabetes in 7, anaemia （HB〈9g/dl） in 3 and limbs open injury in 3 cases. The data was analyzed retro- spectively. All patients underwent bacterial culture of wound secretion, wound debride and continues lavage. To keep the fixator for a negative culture result and to remove it if the result is positive or fixator loose as conformed by imageology or delayed infection was noted. After operation, the antibiotics should be given ac- cording to the results of drug susceptibility test. Results： All patients got a satisfactory effect. Lower back pain relieved markedly and no one＇s neurologic symptoms aggravated postoperatively, No one had infection recurrence during follow-up period, and bony fusion was noted 6 months later. Conclusion： Deep wound in- fection after lumbar spinal operation is a severe post-op complication, it should be diagnosed and treated early. Preoperative comorbidities treatment, reasonable antibiotic application, thorough debridement and continues irrigation and drainage can get a good clinical effect. If necessary the immediate stability of spine can be sacrificed in order to get the result of thorough debridement.