腰椎后路椎间融合术后伤口深部感染的处理

目的评估手术清创或保守治疗方法在腰椎后路椎间融合术后伤口深部感染治疗中的临床疗效。方法收集2001年1月-2005年1月收治的213例因腰椎退行性疾病而接受后路椎间融合内固定术患者的临床资料,对其中7例确诊为伤口深部感染患者（3.3%）采用手术清创或者延长抗生素使用时间等保守治疗,6例患者行手术清创,1例使用针对性较强的敏感抗生素治疗。手术清创者在术中分别使用体积分数为2%的过氧化氢、生理盐水反复浸泡、冲洗伤口,质量浓度为0.1%的苯扎溴铵和生理盐水冲洗后明胶海绵填塞消灭死腔,严密缝合伤口。结果 1例患者取出内固定,有2例患者椎间融合器位置重置。术后延长抗生素静脉滴注和口服时间,直至红细胞沉降率和血常规白细胞计数达正常后3-4d。术后随访时间2.5-6.4年,平均3.6年。随访期内无再次感染的患者。Oswestry残障评分显示3例患者下肢功能轻度残碍,3例中度残障,1例患者重度残障。结论腰椎椎间融合术后深部椎间隙感染没有必要取出椎间融合器,可以采用手术清创或保守治疗等方法处理。

The treatment of deep wound infection after posterior lumbar interbody fusion

Objective To evaluate and compare the long-term treatment outcomes of patients with infected posterior lumbar interbody fusion（PLIF） managed with surgical debridement and or prolonged antibiotic treatment without removal of the interbody cages.Methods Between January 2001 and January 2005,7 of 213 patients underwent PLIF were diagnosed with deep wound infection（3.3%）.All these patients were treated with the surgical debridement（6 patients）of prolonged antibiotic treatment（1 patient） according to the laboratory test results and the sensitive antibiotics.Six patients were managed using the surgical debridement,after the wound was opened,we choose to using the 2% hydrogen solution,Sodium chloride to clear the wound,and benzalkonium bromide,sodium chloride wash the wound and primary closure of the wound.Results None of the patients required removal of the instrumentation.In 2 patients,the PLIF cage were replaced,All 7 patients received prolonged intake intravenous antibiotic therapy and/or oral antibiotic administration,the sign of antibiotic discontinuous was the white cell count and blood sedimentation returned normal returned to normal level.All infected patients were clinically followed for 2.5 to 6.4 years,and 3.6 years for average.During follow-up period,no clinical or laboratory signs of recurrent infection were evident.Four of the 7 patients reported improved clinical status compared with their perfusion status.During follow-up period,there were 3 patients with minimal disability according to the Oswestry Disability Index and 3 with moderate disability with residual leg pain.Conclusion In cases of postoperative deep wound infection after PLIF with cages,removal of the interbody implants is not necessary.Treatment is composted of prolonged antibiotic therapy guided by antimicrobial susceptibility of the isolated bacteria and supplemented with extensive surgical debridement if needed.