腰椎术后椎间隙感染的临床诊治分析

Analyses of clinical diagnosis and treatment of intervertebral space infection after lumbar operation

目的:对腰椎术后椎间隙感染的临床诊断和治疗进行探讨,以期提高相关并发症的防治水平。方法:回顾性分析腰椎间盘切除术后并发椎间隙感染的18例患者的诊断和治疗方法,分析术后椎间隙感染病因,比较手术治疗和保守治疗两种方法在治疗效果、住院时间、住院费用等方面的差异。结果:8例患者保守治疗,10例手术治疗;症状持续平均时间2.6个月,平均住院时间1.2个月,平均住院费用2.54万元;其中,保守治疗组与手术治疗组相比,两者疗效和费用方面差异无统计学意义(P>0.05),两组住院时间比较差异有统计学意义(P<0.05),保守治疗组住院时间长;8例保守治疗患者严格卧床制动,早期联合应用足量广谱抗生素,10例手术治疗患者术后6～8周戴腰围离床活动;治愈后平均随访2年(1～4年),均取得良好预后。结论:腰椎间盘术后椎间隙感染患者早期诊断并联合应用足量抗生素,可获得临床治愈。对于红细胞沉降率>60 mm/h,并伴有发热,白细胞计数明显升高,腰痛剧烈、腰部活动受限明显的患者,采取后路病灶清除、植骨融合、保留内固定的手术治疗方法,可获得较保守治疗更好的疗效。

Objective To study the diagnosis and treatment of intervertebral space infection after lumbar operation and to improve the prevention and treatment of related complications. Method Eighteen cases of intervertebral space infection after lumbar intervertebral disc operation from 2003 to 2010 were retrospectively analyzed. The causes of intervertebral space infection were investigated,and the difference of clinical effects, hospital stays and hospital fees were compared between operation group and conservative treatment group. Results Of the 18 cases,8 were treated with non -surgical method,and 10 were treated by surgical operation. Duration of symptoms was an average of 2. 6 months, the average hospital stays was 1.2 months, and hospitalization costs were an average of 25400 Yuaru When the conservative treat- ment group was compared with the surgical group, both the efficacy and hospital fees had no significant difference （ P 〉 0.05 ）, while the former owned longer hospital stays （ P 〈 0. 05 ）. Eight cases of non - operation group were treated with early application of sufficiency of broad spectrum antibiotics without ambulation;ten cases of surgical group ambulated with a waist brace 6 to 8 weeks after dehridement oper- ation. In the average 2 - year follow - up （ range from 1 to 4 years） ,all the 18 patients resumed their normal life. Conclusion The interver- tebral space infection after lumbar operation in patients can be cured by early diagnosis and joint application of sufficient antibiotics. For the patients accompanied with ESR 〉 60 mm/h ,fever,significant increase of white blood cell counts, severe low back pain and obvious limitation of lumbar activity, the surgery of posterior debridement, autograft fusion and retention of internal fixation has more advantages over the conservative treatment.