保留内置物清创联合真空负压封闭引流治疗早发性腰椎融合术后感染

目的回顾分析保留内置物清创联合真空负压封闭引流治疗早发性腰椎融合术后感染的疗效。方法785例腰椎后路融合病例中术后早发性深部伤口感染6例，均为术后30d内出现发热、疼痛加重等症状，并伴有炎性指标升高，均采用保留内置物，彻底清创后持续冲洗负压引流，抗炎治疗。结果清创术后腰痛即明显缓解，体温下降，2周左右伤口渗液停止，疼痛消失，血常规和C反应蛋白检查结果正常，血沉明显下降。随访平均35．3个月，末次随访时X线片提示腰椎植骨融合。JOA评分改善率为82．2％。结论对于早发性腰椎融合术后感染病例，进行积极清创手术，保留内置物联合真空负压封闭引流能够及时控制感染，是一种较为有效的处理。日服抗生素抑菌治疗可以降低清创术术后感染复发。

Combined debridement with implant retained and vacuum sealing drainage for management of early-onset wound infections after lumbar spinal fusion

Objective Retrospective study of the efficacy of combined debridement with implant retained and vacuum sealing drainage for management of early-onset wound infections after lumbar spinal fusion. Methods A total of 6 patients with early-onset deep wound infections were involved in this study from 785 cases of posterior lumbar spinal fusion. The cases typically presented with fever, increasing pain accompanied with elevated level of C reactive protein and erythrocyte sedimentation rate within 30 d of implant placement. All of them underwent combined debridement with implant retained, vacuum sealing drainage and intravenous antibiotic therapy. Results Lumbar pain and body temperature were improved immediately after the debridement. After 2 weeks treatment, the wound seepage ceased and the pain of lumbar spine disappeared. The laboratory markers such as C reactive protein and erythrocyte sedimentation rate were also improved. The average follow-up was 35.3 months. At the final follow-up, solid fusion was achieved in all the patients according to the roentgenographs. The improvement rate of JOA score was 82.2%. Conclusion Combined debridement with implant retained and vacuum sealing drainage is an effective management for the patients with early-onset wound infections after lumbar spinal fusion. Oral antibiotics inhibition therapy can decrease the recurrence of infections after debridement.