脊柱后路内固定术后迟发性感染的治疗

The treatment of delayed infection following posterior instrumented spinal surgery

目的：探讨脊柱后路内固定术后迟发性感染（首次感染发生时间≥术后1个月）病例的治疗方法 ,并进行分析总结。方法：自2005年8月~2013年12月共收治脊柱后路内固定术后迟发性感染病例18例,其中颈后路单开门椎管扩大成形术1例,腰椎后路减压固定融合术17例,单纯切口深部感染9例（组1）,单纯椎间隙感染7例（组2）,同时合并切口深部及椎间隙感染2例（组3）,分析迟发性感染的特点,比较3组迟发性感染在体温、炎症指标（WBC计数、ESR、CRP）、临床表现等方面的差异,并进行相应治疗。结果：发生迟发性感染的平均间隔时间为术后17个月（1~101个月）,三组病例间感染在发病时间、体温、WBC、ESR、CRP中,仅组2与组3间的体温存在统计学差异（P〈0.05）,其余检验均无统计学差异（P〉0.05）;组1中8例患者行清创＋对口冲洗引流术,其中4例取出内固定,组2中1例合并局部不稳定行手术治疗,组3中1例因明显的深部感染行手术治疗,其余病例单纯应用抗生素治疗。所有病例均获治愈,平均随访18个月（12~40个月）,未见感染复发。结论：对迟发性脊柱后路术后切口深部感染病例,清创＋对口冲洗引流术是有效治疗,对于手术节段融合满意的患者,可积极取出内固定;迟发性单纯椎间隙感染,首选抗生素保守治疗,对于合并明显的切口深部感染或存在不稳定的病例,可行手术清创治疗。

Objectives： To investigate the treatment of delayed infection（first onset time more than 1 month）following posterior instrumented spinal surgery. Methods： From August 2005 to December 2013, 18 cases with delayed infection following posterior instrumented spinal surgery were treated, including posterior cervical laminoplasty in 1 case and posterior lumbar decompression and fusion in 17 cases. There were 9 cases with delayed deep incision infection（group 1）, 7 cases with delayed intervertebral space infection（group 2）, 2 cases with both delayed deep incision and intervertebral space infection（group 3）. The characteristics of delayed infection were analysed, the temperature, inflammation index（WBC, ESR, CRP）, clinical manifestation among these 3 groups were compared, and the corresponding treatment were performed. Results： The average onset time of delayed infection was 17 months postoperatively（1-101 months）. There was no significant difference in the onset time, temperature, WBC, ESR, CRP among 3 groups（P〉0.05）, except for the temperature between group 2 and group 3（P〈0.05）. In group 1, 8 cases underwent reoperation（debridement, washing and drainage）,among whom 4 cases received instrument removal. In group 2, just 1 case with local instability was treated by reoperation, while 1 case with obvious deep infection was treated by reoperation in group 3. The other cases were treated with antibiotics only. All the cases were cured and followed up for an average of 18months（12-40 months） with no recurrence of infection. Conclusions： Surgery（debridement, washing and drainage） is effective for the delayed deep incision infection. It is recommended to remove internal fixation for the cases with solid segmental fusion. Conservative treatment with antibiotics is the preferred choice for simple delayed intervertebral space infection, but surgery is still feasible while the patient is complicated with obvious incision deep infection or instability.