脊柱后路内固定术后早期伤口感染危险因素分析及治疗方法的研究

Risk factors for early wound infections after spinal posterior fixation surgery and treatment measures

目的研究脊柱后路内固定术后早期伤口感染的原因、治疗方法及预后转归,为其临床治疗提供依据。方法将医院2000年1月-2012年1月292例脊柱后路内固定术患者,分为非感染组280例与早期感染组12例,比较两组随访结果,将12例早期感染患者按不同治疗方法分为A、B、C组,A组(3例)采用切开引流+伤口换药+对症支持+静脉滴注抗菌药物四联疗法,B组(5例)在A组治疗基础上加清创缝合五联疗法,C组(4例)在B组治疗基础上加抗菌药物伤口持续灌洗六联疗法,针对12例早期感染患者进行感染原因、不同治疗方法及其预后的分析。结果疗效优良率早期感染组为91.67%,非感染组为94.64%,两组比较差异无统计学意义;手术时间>2h、年龄>55岁、伴慢性基础疾病、术前有开放性伤口为早期感染的危险因素;症状恢复时间(14.5±1.6)d、体征消失时间(16±1.2)d及临床检验值恢复正常时间(18.5±1.4)d六联疗法均明显优于其他两种治疗方法;金黄色葡萄球菌和表皮葡萄球菌是早期伤口感染的主要致病菌,分别占66.7%和16.7%。结论脊柱后路内固定手术后早期感染要早发现、早诊断、早治疗,六联疗法能够及时控制并消除感染,改善患者的预后。

OBJECTIVE To investigate the causes of early wound infections after spinal posterior fixation surgery, put forward the treatment measures and evaluate prognosis outcomes so as to guide the clinical treatment. METHODS A total of 292 cases of patients who underwent the spinal posterior fixation surgery in the hospital from Jan 2000 to Jan 2012 were enrolled in the study and were divided into the non-infection group with 280 cases and the early infection group with 12 cases , the 12 cases with early infections were divided into the group A, B, and C according to the treatment measures, then the group A （3 cases ） was treated with incision and drainage plus wound drug dressing, symptomatic supportive treatment and intravenous infusion of antibiotics, the group B was additionally treated with debridement and suture based on the treatment of the group A, and the group C was additionally treated with continuous wound irrigation; the causes of the early infections in 12 cases, treatment measures, and outcomes were analyzed. RESULTS The rate of excellent outcome was 94.67 % in the early infection group, 94. 64% in the non-infection group, the difference between the two groups was not significant. The operation duration more than 2 hours, more than 55 years of age, and preoperative open wound were the risk factors for the early infections. The symptom recovery time, sign disappearance time, and time of clinical labora- tory value returning to normal of the six-step treatment method were respectively（14.5 ! 1.6）d, （16 ~ 1.2 ）d, and （18.5! 1.4）d, significantly better than those of other two treatment methods. Staphylococcus aureus and Staph- ylococcus epidermidis were the predominant species of pathogens causing the early wound infections, accounting for 66.7% and 16.7%, respectively. CONCLUSION The early infections after spinal posterior fixation surgery should be discovered, diagnosed, and treated in early stage, and the six-step treatment method can control and eradicate the infections in a timely manner and improve the prognosis.