闭式冲洗引流联合VSD治疗早发腰椎内固定术后感染临床探讨

Combined suction- drainage and VSD for treatment of early- onset infection after lumbar instrumentation

目的探讨应用闭式冲洗引流联合VSD治疗早发腰椎内固定术后感染。方法回顾性分析郑州大学第二附属医院2009年9月—2012年3月5例早发腰椎内固定术后感染患者,根据细菌培养及药敏结果,静脉应用敏感抗生素,保留内置物,早期行清创手术,术中切口内留置冲洗管一根,引流管两根,一期缝合切口,应用敏感抗生素盐水冲洗,切口外置VSD,根据细菌培养结果去除置管及VSD。结果 5例患者冲洗14～21d,平均17d,抗生素应用12周,均获得清创术后一期切口愈合,感染控制,血沉、C反应蛋白、白细胞降至正常水平,腰部症状消失,随访12个月～27个月,无感染复发。结论对于腰椎内固定术后早发感染早期行清创术,术后给予置管闭式冲洗引流,外置VSD是一种简单易行、有效的处理方法,联合应用敏感抗生素可有效控制感染、降低复发率,保留了内置物及植骨块,维持了脊柱稳定性。

Objective To study application of closed- suction drainage and VSD for treatment of early- onset infection after lumbar instrumentation. Methods Retrospective study of 5 patients with early- onset infections after lumbar instrumentation in the group from September 2009 to march 2012. According to the germiculture and sensitivity results,manage the patients by instravenous infusion of sensitivity antibiotics,aggressive debridement and irrigation,without implants removal,and primary closure. The group applied antibiotics saline flush and placed the VSD outside the incision. Remove the catheter and VSD according to the results of bacterial culture. Results All of the five patients achieved primary healing of incisions after rinse 14 ～ 21 days（17 days on average） and application of antibiotics for 12 weeks,The serum Wbc level,ESR level,and CRP level decreased to normal levels,and lumbar symptoms disappeared. The followed up date of 12 ～ 27 months（17. 4 months on average） showed no infection recurrence. Conclusion It is an easy and effective way to apply closed- suction drainage after aggressive debridement,combined with VSD in order to treat the early- onset infection after lumbar instrumentation. In additionally,the combination of sensitive antibiotics can control the infection effectively and reduce the relapse rate. At the same time,retained implant and graft to maintain the stability of the spine.