腰椎内固定术后不典型迟发性伤口感染临床研究

Clinical Study of Atypical Delayed Wound Infection after Internal Fixation of Spine

目的:分析腰椎内固定术后不典型迟发伤口感染的原因及致病菌,探讨诊断及治疗方法。方法:收集23例腰椎内固定术后发生的伤口感染病例,分析发生感染原因,调查引起感染的常见致病菌。23例均根据临床表现结合影像学及细菌培养确诊。均再次手术取出内固定,清除伤口内炎性肉芽组织,骚刮钉道,冲洗引流,应用敏感抗生素等方法治疗。结果:23例腰椎内固定术后发生不典型迟发伤口感染的常见致病菌为表皮葡萄球菌、大肠杆菌、类白喉杆菌等,经再次手术治疗后伤口均一期治愈,随访1～3年,无复发。结论:腰椎内固定术后迟发伤口感染的症状不典型,结合病史、症状、实验室检查仍和做出诊断,再次手术取出内固定是治愈的关键。

Objective To analyze the causes and pathogenic bacteria of atypical wound infection after internal fixation of spine, and to study the diagnosis and treatment. Methods 23 patients suffered from delayed post-operative wound infection were reviewed, the clinical symptoms, laboratory examination, surgery treatment and culture reports were analyzed. None of them has skin sinus tract and most of them have local pain,fever,radiated pain and numb of lower limbs, faster erythrocyte sedimentation rate （ESR）,increased C reactive protein. The internal fixations were removed from all patients, the patients underwent debridement, lavage and drainage, the specimen obtained in the operation was sent to bacteria culture, antibiotics were used after operation. Results all of the 23 patients obetainde primary healing. All of these 23 patients were followed up for 12 - 36 months and no complication reoccurred. Conclusions Because there is no typical symptoms, the diagnosis of atypical delayed post-operative infection after internal fixation of spine is difficult, but we still can make correct diagnosis of this kind of infection. Satisfactory