青少年特发性脊柱侧凸矫形术后并发感染对患者手术疗效及生存质量影响研究

Analysis on the quality of life in the postoperative adolescent idiopathic scoliosis patients with infection

目的探讨青少年特发性脊柱侧凸术后并发感染对患者手术疗效及生存质量影响的研究。方法收集2007年1月～2007年12年在我院行脊柱侧凸矫形手术的AIS患者210例,按术后发生与未发生感染将患者分为2组,术后随访时间大于2年。详细分析患者的病历资料,包括手术前后及随访时的放射学参数、手术中数据及患者填写SRS-22量表结果,将两组患者的各项数据进行相应的统计学检验,以<0.05作为检验标准。结果 210例患者中,9人发生感染﹙4.2%),3例发生急性感染﹙术后15天﹚,6例发生迟发性感染﹙平均35.2个月﹚,临床表现以背部疼痛﹙7例﹚、局部肿胀﹙5例﹚及切口渗液﹙4例﹚为主。5例感染患者行外科置管冲洗、清创及内固定物移除术治疗,2例患者最终行内固定物移除术治疗,术后4～8周静脉应用抗生素治疗,感染组术后矫正率低于未感染组﹙P<0.05﹚,SRS-22量表填写结果在疼痛、功能、自我形象、心理健康四个维度得分两组间无明显统计学意义(P>0.05)。患者治疗满意度维度感染组得分低于未感染组(P<0.05)。结论脊柱侧凸矫形术后感染并发症可经外科置管冲洗、清创、内固定物移除术及静脉应用抗生素治愈,术后感染发生导致原有矫正率丢失,患者对治疗满意度降低。

Objective To analyze the quality of life in the postoperative adolescent idiopathic scoliosis patients with infection.Methods From Jen 2007/1 to Dec 2007 in our hospital,210 postoperative AIS patients were separated into two groups（infected or non-infected）,following up at least 2 years.The parameters in the case records were collected and analyzed in detail,including preoperative,immediate postoperative,and after-2-year postoperative radiographic measurements,and SRS-22 outcomes.The parameters between the two groups were compared with statistic methods,taking P0.05 as a significant standard.Results Among 210 patients,9 cases（4.2%） suffered an infection.There were 3 acute（15 days postoperative） and 6 delayed（average 35.2 months postoperative） infected patients.The main clinical manifestation included back pain（7 of 9）、local swelling（5 of 9） and incision exuding（4 of 9）.5 infected patients were treated with surgery,such as irrigation by putting catheters,debridement.2 patients with implants removal,besides 4～8 weeks＇ intravenous antibiotics.Compared with the non-infected patients,those with infection had a lower percent curve correction（P0.05）.There were no significant differences in the aspects of pain,function,self-image,or mental health of SRS-22 outcomes between the two groups（P0.05）.The infection group had a lower score in the aspect of satisfaction of SRS-22 outcomes compared with non-infection（P0.05）.Conclusion The complication of infection after surgery of idiopathic scoliosis can be cured with irrigation by putting catheters,debridement and implants removal,combined with a course of antibiotics.However,lower curve correction could be achieved in the infected patients,and the satisfaction with the therapy in these patients reduced.