腰椎内固定术后椎间隙感染的临床分析及诊疗探讨

To Investigate the Diagnosis and Treatment of Postoperative Intervertebral Discitis of Lumbar Internal Fixation

目的分析及探讨腰椎内固定术后发生的椎间隙感染的危险因素、发病特点及诊治方法。方法回顾性分析我院骨科2000年至2011年944例腰椎内固定术后中的14例椎间隙感染的诊治。其中男10例,女4例;平均年龄52岁。非手术治疗9例,手术治疗5例,随访时间1年。结果所有患者症状6个月后完全消失;经过半年随访疗效满意,血沉正常。3~6个月复查X线片示相邻椎体间融合骨桥形成有12例,有2例无骨性融合,均恢复劳动力。结论腰椎内固定术后隙感染患者,对于革兰阴性菌感染者易发展为感染性休克危机生命需立即行手术病灶清除治疗;对于革兰阳性菌感染者早期应用强效抗生素抗感染治疗,有望避免再次手术干预。

Objectives We aimed to analyze the risk factors, clinical features, diagnosis and treatment strategies of intervertebral disc infection after lumbar internal fixation and to assess the effective treatment. Methods A retrospective study was conducted in 944 patients of postoperative lumbar internal fixation from the Third Xiangya Hospital of Central South University （Changsha, China） during 2000 to 2011. Fourteen patients had confirmed diagnosis of intervertebral infection, including 10 males and 4 females, and the mean age was 52 years. Of which five patients underwent surgical treatment, others were treated with drugs combined with bed resting. All the subjects after treatment were followed-up one year. Results Both operation group and non-operation group achieved excellent outcomes during the follow-up of 6 months, all the patients fully recovered after six month, and their erythrocyte sedimentation rate level were in the normal range. 3-6 months later, all the patients returned to work, and the X-ray films showed that between adjacent vertebrae bone bridge fusion was formed in 12 patients, while 2 patients without bone fusion. Conclusion In the patients suffered from intervertebral disc infection after lumbar internal fixation, the Gram-negative infections are tended to develop life-threatening septic shock, which required immediate surgical debridement and treatment, while for the Gram-positive bacterial infections, early using of potent antibiotics is expected to avoid further surgical intervention.