腰椎内固定术后感染的原因与治疗分析

Causes and treatment of postoperative infections in patients undergoing lumbar internal fixation

目的探讨腰椎内固定术患者手术切口感染的发生原因、诊断方法和治疗对策,为其术后感染的预防、诊断和治疗提供参考依据。方法选取医院2013年5月-2015年5月收治的673例行腰椎内固定术患者临床资料进行观察统计,对术后发生手术切口感染患者的临床资料进行统计分析,根据结果判断导致术后感染的主要因素,并总结相应的治疗对策。结果术后发生手术切口感染的共13例,感染率为1.90%;年龄〈45、45～60岁及〉60岁患者手术切口感染率分别为0、2.34%及3.61%（χ2=0.052,P=0.027）;患有基础疾病0～2、〉2种患者手术切口感染率分别为0.65%～1.80%、3.82%（χ2=0.047,P=0.031）;手术时间〈90、90～180min及180～300min患者手术切口感染率分别为0.42%、1.97%、4.62%（χ2=0.044,P=0.019）;细菌培养结果显示,引发术后手术切口感染的主要病原菌为金黄色葡萄球菌。结论对腰椎内固定术后手术切口感染的发生应以预防为主,尤其关注年龄〉60岁、合并两种以上基础疾病、手术时间180～300min的高危患者,一旦发生感染立即给予积极治疗。

OBJECTIVE To explore the causes of surgical incision infections in patients undergoing lumbar internal fixation and put forward the countermeasures for diagnosis and treatment so as to provide guidance for prevention,diagnosis,and treatment of the postoperative infections.METHODS The clinical data were collected from 673 patients who underwent the lumbar internal fixation from May 2013 to May 2015,the clinical data of the patients with postoperative surgical incision infections were statistically analyzed,the major factors for the postoperative infections were observed,and the targeted treatment countermeasures were put forward.RESULTS The postoperative incision infections occurred in 13 patients,with the infection rate 1.90%;the incidence rate of surgical incision infections was 0in the patients aged less than 45 years old,2.34%in the patients aged from 45 to 60years old,3.61%in the patients aged more than 60 years old（χ2=0.052,P=0.027）.The incidence rate of surgical incision infections varied from 0.65%to 1.80%in the patients with less than 2kinds of underlying diseases,3.82%in the patients with more than 2underlying diseases（χ2=0.047,P=0.031）.The incidence rate of surgical incision infections was 0.42%in the patients with the operation duration less than 90 min,1.97%in the patients with the operation duration varying from 90 to 180 min,4.62% in the patients with the operation duration varying from180 to 300min（χ2=0.044,P=0.019）.The result of bacterial culture indicated that the Staphylococcus aureus was the predominant species of pathogen causing the postoperative surgical incision infection.CONCLUSIONIt is necessary to focus on the prevention of the postoperative surgical incision infections in the patients undergoing the lumbar internal fixation,especially the high-risk patients,including the patients aged more than 60 years old,the patients complicated more than 2types of underlying diseases,and the patients with operation duration varying from 180 to 300min;active treatment should be conducted immediately once the infections occur.