腰椎管狭窄症椎体间植骨融合术后急性切口深部感染的处理

目的:探讨下腰椎后路椎管减压、椎体间植骨融合(PLIF)术后急性切口深部感染的治疗方法与临床效果。方法:回顾性分析2005年12月至2010年12月收治的10例下腰椎PLIF术后急性切口深部感染治疗资料,其中男4例,女6例;年龄34～70岁,平均52.8岁。所有患者采用病灶清除、冲洗引流加抗生素应用治疗,比较手术前后VAS,ESR,CRP及下腰痛JOA评分变化,评估临床效果。结果:所有患者获随访,时间19～28个月,平均24个月。1例椎间隙感染者取出椎体间融合器,保留内固定螺钉,1例清创术后感染进行性加重,出现中枢感染猝死,其余8例术后恢复良好,下腰痛VAS评分由术前8.0±0.4下降至术后2.8±0.3;JOA评分由术前10.30±3.02改善至术后24.10±2.85。ESR由术前(85.0±17.0)mm/h下降至术后(14.0±6.0)mm/h;CRP由术前(73.5±14.3)mg/L下降至术后(5.1±1.1)mg/L;WBC由术前(11.1±1.8)×109/L下降至(7.4±0.5)×109/L。结论:腰椎管狭窄症PLIF术后切口深部感染早期行伤口切开、清创、病灶清除冲洗引流,保留内固定物,敏感抗生素应用可取得良好临床效果。术前对高危因素的预防处理尤为重要,对于确诊的腰椎后路深部感染患者,保守治疗无效,需早期手术治疗。

Surgical treatment of postoperative deep wound infection after posterior lumbar interlumbar fusion of the lumbar stenosis

Objective:To study surgical treatment for the deep wound infections after the operation of posterior lumbar interlumbar fusion(PLIF) in lumbar spinal stenosis. Methods:From December 2005 to December 2010,10 patients with the deep wound infection of the PLIF were analyzed retrospectively,including 4 males and 6 females,with a mean age of 52.8 years(ranged from 34 to 70 years). All the patients were treated with debridement and the drainage. The sensitive antibiotics were used. The VAS score,erythrocyte sedimentation rate(ESR),C reactive protein(CRP),and JOA lumbar score were used to compare the clinical results pre-and post-operation. Results:All the patients were followed up,and the mean duration was 24 months(ranged from 19 to 28 months). One patient developed to an intervertebral space infection and the cage was removed. One patient suffered a radical central nerve system infection and died after the debridement. Other 8 patients got a good clinical result. The VAS score decreased from preoperative 8.0±0.4 to postoperative 2.8±0.3;JOA score improved from preoperative 10.30±3.02 to postoperative 24.10±2.85;ESR decreased from preoperative(85.0±17.0) mm/h to postoperative(14.0±6.0) mm/h; both CRP and WBC decreased from preoperative (73.5±14.3) mg/L,(11.1±1.8) ×10⁹/L to postoperative (5.1±1.1) mg/L,(7.4±0.5) ×10⁹/L respectively. Conclusion:Treatment of patients with deep wound infections after PLIF with debridement,drainage,and sensitive antibiotics could get a good long-term clinical result,which is important to treat the patients with high-risk factors. Early diagnosis and operation is the key to deal with the patients with deep wound infections after PLIF.