脊柱后路椎弓根螺钉系统内固定术后感染临床分析

目的]探讨脊柱后路椎弓根螺钉内固定系统术后感染的危险因素、诊断及处理方法。方法]对脊柱后路椎弓根螺钉系统内固定术后并发感染的16例患者的手术时间、术中失血量、围手术期抗生素的使用、临床表现、实验室检查、细菌培养等进行回顾性分析。结果]本组541例患者，术后感染发生率为2．98％，手术时间60min以内、60～120min、大于120min术后感染发生率依次为0．00％，3．04％，5．90％；术中失血量〈400ml，400～800ml，〉800ml术后感染发生率分别为2．12％，3．15％，11．16％；术后使用抗生素，术中术后使用抗生素，术前术中术后均使用抗生素，术后感染发生率分别为1．10％，4．32％，10．25％。15例取出内固定者及1例未取出者，切口均甲级愈合。16例患者二次手术后随访11～23个月，均无复发征象。结论]脊柱后路椎弓根螺钉系统内固定术后感染与手术时间、术中失血量有关，手术失血量越多，手术时间越长，术后越易发生感染，围手术期使用抗生素可有效减少感染的发生；确诊后病灶清除，内固定物取出，灌洗引流，静脉应用有效抗生素，可获得满意疗效。

Clinical analysis of post-operative infection after internal fixation of spine

Objective] To study the risk factor, diagnosis and treatment of post-operative infection after internal fixation of spine. Method ] A total of 541 cases of internal fixation of spine were reviewed and 16 cases of postoperative infection were studied. Operation time, blood lost, antibiotics administration, clinical symptoms, laboratory tests and culture reports were studied. The internal fixations in all 16 patients were removed and the patients underwent debridement and lavage. The specimen obtained in the operation was sent to bacteria culture. One ease of acute infection underwent debridement and lavage after postoperative administration of antibiotics. Result] The post-operative infection rate of 541 patients was 2. 98%. The infection rates related to different operation time of less than 60 rain, more than 60 rain to 120 rain, more than 120 rain were 0. 00% , 3.04% , 5.90 respectively ; the infection rates related to different blood lost of 100 to 400ml, 400 to 800ml, more than 800 mt were 2. 12%, 3. 15%, 11.16% respectively; the infection rates related to different antibiotic administration in operation, both in operation and post-operation, and in pre-operation, operation and post-operation were 1.10%, 4. 32%, 10. 25% respectively. All patients experienced wound healing. All these 16 patients were followed up for 11 - 23 months and no complication reoccurred. Conclusion] The occurrence of post-operative infection after internal spinal fixation was related to operationtime, blood lost. Antibiotics may be an effective method for prevention of infection. The surgical procedures should include debridement, internal fixation removal, lavage and antibiotics administration.