Abstract:Objective To explore the feasibility of treating postoperative infection of thoracolumbar spine in the case of retaining internal fixation with a series of treatment methods, such as changing drugs, removing the lesion, expanding the drainage and using sensitive antibiotics. Methods The clinical data of 16 patients with postoperative infection of thoracolumbar spine treated in the Second People's Hospital of Hefei from January 2012 to May 2015 were analyzed retrospectively. In the case of retaining internal fixation, after a series of treatment methods, such as changing drugs, removing the lesion, expanding the drainage and using sensitive antibiotics, the wound healing was observed. The white blood cell (WBC) number, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and visual analogous scale (VAS) were analyzed and compared before and after treatment. Results All patients wound healing were well. Follow-up time was from 6 months to 2 years, and no case recurred. After treatment, the WBC number, ESR, CRP and VAS score were lower than those before treatment, with statistically significant difference (P < 0.05). Conclusion It is necessary to clearly diagnose the postoperative infection of thoracolumbar spine in the early stage, and actively take the active treatment, such as changing drugs, removing the lesion, washing the drainage, etc. In the case of retaining internal fixation, it can also achieve good curative effect.
王绍钱 王徽▲ 牛磊 魏龙雨. 保留内固定治疗胸腰椎术后感染的体会[J]. 中国医药导报, 2018, 15(3): 81-84.
WANG Shaoqian WANG Hui▲ NIU Lei WEI Longyu. Experience of treatment for postoperative infection of thoracolumbar spine without removing internal fixation. 中国医药导报, 2018, 15(3): 81-84.
[1] Dipaola CP,Saravanja DD,Boriani L,et al. Postopeative infection treatment score for the spine(PITSS):construction and validation of a predictive model to define need for single versus multiole irrigation and debridement for spinal surgical site infectin [J]. Spine J,2012,12(3):218-230.
[2] 魏军渔.脊柱术后急性感染的治疗策略探讨[J].脊柱外科杂志,2014,12(4):208-211.
[3] 林旭,谭伦,曾俊,等.保留内固定植入物治疗胸腰椎术后感染[J].中国组织工程研究,2015,19(4):537-542.
[4] 蔡斌,王文军,胡文凯,等.腰椎内固定术后深部感染的治疗体会[J].医学临床研究,2016,33(8):1630-1631.
[5] Parra JLC,Martin SA,Martinezaedo ALU,et al. Management of infectious discitis. Outcome in one hundred and eight patients in a univemity hospital [J]. Int Orthop,2012, 36(2):239-244.
[6] 李昭,杨连根,王琳,等.胸腰椎内固定术后感染的临床诊疗分析[J].河北医科大学学报,2014,35(10):1207-1208.
[7] 范萍,刁红霞,张琳,等.脊柱术后围手术期内切口感染因素回顾性分析与防护措施[J].中华医院感染杂志,2011, 21(11):2240-2241.
[8] 严峻,郑勇,谢耀杰,等.胸腰椎后路术后切口感染的治疗策略[J].颈腰痛杂志,2016,37(2):115-117.
[9] Yano MH,Klautau GB,Da silva CB,et al. Improved diagnosis of infection associated to osteosvnthesis by use of sonication of fracture-fixation lmplants [J]. J Clin Microbiol,2014,52(12):4176.
[10] 董永强,何鑫东,潘山,等.后路脊柱术后早期感染病原学与临床治疗效果分析[J].中华医院感染学杂志,2015, 25(6):1351-1353.
[11] 胡袒,伍骥,郑超.脊柱围手术期手术部位感染的诊断及预防研究进展[J].中国矫形外科杂志,2016,24(7):631-635.
[12] 付能高,张映波,张志明.VSD结合灌洗引流治疗胸腰椎术后切口感染[J].实用骨科杂志,2014,20(1):145-147.
[13] 陈飞,吕国华,康意军,等.胸腰椎后路内固定术后深部感染的治疗[J].中华外科杂志,2005,20(43):1325-1327.
[14] 庄泽民,李强.胸椎骨折术后感染经皮固定器治疗一例[J].中国骨与关节损伤杂志,2011,26(8):713.
[15] Pull ter gunne AF,Cohen DB. Incidence,prevalence,and analysis of risk factors for surgical site infection following adult spinal surgery [J]. Spine(Phila Pa 1976),2009, 34(13):1422-1428.
[16] Nunez-pereira S,Pellise F,Rodriguez-pardo D,et al. Implant survival after deep infection of an instrumented spinal fusion [J]. Bone Joint J,2013,95-B(8):1121-1126.
[17] Messina AF,Berman DM,Ghazarian SR,et al. The management and outcome of spinal implant-related infections in pediatric patients:a retrospective review [J]. Pediatr Infect Dis J,2014,33(7):720-723.
[18] 曾忠友,金才益,王斌,等.下腰椎病变椎弓根螺钉系统内固定术后急性感染的治疗[J].脊柱外科杂志,2015,8(6):359-361.
[19] 梁志强,李伟,王增星,等.后路手术对腰椎间盘术后椎间隙感染的疗效分析[J].中国医药科学,2015,5(6):176-179.
[20] 黄永婵,苏如葵,车红英,等.手术切口感染病原菌分布及药物敏感性研究[J].中国医学创新,2012,9(18):101-103.