老年人腰椎退行性疾病植入物内固定后切口感染的治疗策略

发布时间：2018-03-06 15:40

本文选题：腰椎　切入点：内固定器　出处：《中国组织工程研究》2017年27期 　论文类型：期刊论文

【摘要】：背景:脊柱内固定术后感染是骨科术后常见并发症,治疗方案仍存在争论。老年人腰椎退行性疾病日益增多,内固定术后感染处理无统一治疗方案。目的:探讨和分析老年人腰椎退行性疾病内固定术后切口感染的治疗效果。方法:对2012年1月至2015年1月首都医科大学附属北京世纪坛医院骨科收治并获得2年以上随访的老年腰椎退行性疾病内固定术后患者197例进行回顾性分析,随访时间2-4.9年。其中腰椎管狭窄97例,腰椎间盘突出29例,腰椎滑脱33例,退行性脊柱侧凸17例,腰椎椎体压缩性骨折21例。结果与结论:①197例腰椎退行性疾病内固定术后患者中,11例患者术后出现切口感染,其中10例切口急性感染,1例迟发性感染;②10例急性感染患者中,3例为切口表浅感染,7例为深部感染。急性感染的临床表现包括:切口渗液(10/10),切口局部疼痛(8/10),体温增高(9/10)。治疗方案包括给予细菌培养和药敏实验,同时静滴抗生素,感染局部清创引流冲洗,除了1例患者取出内固定,其余患者均未取出内固定;③迟发性感染患者只有1例,临床表现包括切口局部疼痛、切口渗液及间断性发热,取出内固定;④所有感染患者随访2年后,无假关节发生;(5)结果提示,老年腰椎退行性疾病内固定术后感染患者的治疗可考虑保留内固定物,静滴抗生素,感染区域清创引流冲洗,如果必要的话可反复清创感染区域。
[Abstract]:Background: infection after spinal internal fixation is a common complication after orthopedic surgery, and treatment options are still controversial. The number of lumbar degenerative diseases in the elderly is increasing. There is no unified treatment scheme for infection after internal fixation. Objective: to investigate and analyze the therapeutic effect of incision infection after internal fixation for lumbar degenerative diseases in the elderly. Methods: from January 2012 to January 2015, Beijing University of Medical Sciences. 197 cases of senile lumbar degenerative diseases treated in orthopedic department of Beijing Century altar Hospital and followed up for more than 2 years were analyzed retrospectively. The follow-up time was 2-4.9 years, including 97 cases of lumbar spinal stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis. Results and conclusion 11 of 1197 patients with lumbar degenerative diseases after internal fixation had incisional infection. Of the 210 patients with acute infection, 10 cases were acute infection of incision, of which 3 cases were superficial infection of incision and 7 cases were deep infection. The clinical manifestations of acute infection include incision exudate 10 / 10, incision local pain 8 / 10, body temperature increase. The treatment includes bacterial culture and drug sensitivity tests. At the same time, only one patient with delayed infection without internal fixation was treated by intravenous drip antibiotics, local debridement, drainage, irrigation, except for one patient who had removed internal fixation, and only 1 patient with delayed infection. The clinical manifestations included local pain of incision. Incision exudate and intermittent fever. All the patients with internal fixation were followed up for 2 years without pseudoarthrosis. The results suggested that the treatment of senile patients with infection after lumbar degenerative disease internal fixation could be considered to retain internal fixation. Infuse antibiotics, debridement and wash the infected area, if necessary, repeatedly degrade the infected area.
【作者单位】：首都医科大学附属北京世纪坛医院手术室;通辽市奈曼旗人民医院;首都医科大学附属北京世纪坛医院脊柱外科;
【分类号】：R687.3

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