内置物保留治疗脊柱内固定术后细菌感染8例报告

Implant retention after postoperative infection in patients undergoing instrumented spinal fusion

目的探讨脊柱内固定术后细菌感染发生时在保留内固定物的情况下手术联合药物治疗的效果。方法对来自滨州医学院附属医院的458例脊柱疾患采用脊柱内固定治疗，8例（1．75％）确诊术后感染接受治疗。结果在保留内固定物的情况下，所有确诊感染的患者接受外科彻底清创、抗感染及VSD辅助治疗，感染均得以根治，平均随访时间2．1年（1-2．5年）。结论脊柱内固定术后发生的细菌感染通过积极的手术清创、应用抗生素并联合VSD辅助治疗均可得到控制。结果显示术后细菌感染在不取出内固定物的情况下，可以成功治愈。

Objective To evaluate the efficacy of surgical and medical management of postoperative infections after instrumented spinal fusion without implant removal. Methods All of 458 patients from the Affiliated Hospital of Binzhou Medical College underwent instrumented spinal fusion, 8 patients （1.75%） were identified as postoperative infections, all of them were treated by our department. Results All patients underwent surgical debridement and received antibiotic therapy without implant removal. Eradication of the infection was successful in all patients. The mean follow-up period was 2.1 years （range 1 to 2.5 y）. Conclusion Aggressive surgical debridement and long-term suppressive antibiotic therapy enables infection cure in all patients with postoperative infections after spinal instrumentation with implant retention. Vacuum sealing drainage is used as an adjunct measure. These results show that surgical-site infection （SSI） in the spine can be successfully treated without implant removal.