负压封闭引流术在治疗脊柱术后早期深部感染中的应用

目的探讨负压封闭引流术治疗脊柱后路内固定术后早期深部感染的临床疗效。方法回顾性分析2009年3月-2012年3月采用负压封闭引流术治疗脊柱后路内固定术后早期深部感染患者9例，其中男5例，女4例；年龄21～64岁，平均44．6岁。所有患者均行手术清创，保留原有内固定，并采用负压封闭引流的治疗方式。结果患者经负压封闭引流术治疗1～3次，平均2．1次，每次3～7d；所有患者接受6～38个月的随访，平均18个月，伤口均愈合，无腰痛、切口疼痛、红肿、渗出及窦道形成等；再次行影像学检查未见骨质破坏；复查血沉、C反应蛋白、白细胞总数及分类明显下降或降至正常。结论负压封闭引流术是治疗脊柱后路内固定术后早期深部感染的有效方法。

Vacuum Sealing Drainage for Early Deep Infection after Posterior Spinal Internal Fixation

Objective To analyze the curative effect of vacuum sealing drainage for early deep infection after posterior spinal internal fixation. Methods From March 2009 to March 2012, 9 patients with early deep infection after posterior spinal internal fixation, including 5 males and 4 females aged between 21 and 64 years, averaging at 44.6, underwent debridement and vacuum sealing drainage （VSD）. Original fixtures in all the patients were not taken out. Results The patients were treated by VSD for once to three times with an average of 2.1 times, and VSD continued for 3 to 7 days every time. Two patients underwent one time of VSD, 4 underwent twice, and 3 underwent three times. In these patients, 6 achieved wound healing after VSD, one changed to ordinary dressing and wound suturing two weeks later due to hemorrhage of VSD, one changed to ordinary dressing and wound suturing wound three weeks later due to impeded drainage, one accepted skin-grafting after three times of VSD. All the patients were followed up for 6 to 38 months （18 months on average） and all of them were cured. There was no obvious back pain or signs of incision infection. The X-ray films showed that there were no bone destruction and the white blood cell count, erythrocyte sedimentation rate, and C-reactive protein significantly decreased to normal after surgery. Conclusions One-stage debridement and vacuum sealing drainage therapy is an effective method for treating early deep infection after posterior spinal internal fixation.