老年人腰椎退行性疾病植入物内固定后切口感染的治疗策略

Treatment strategy for incision infection after internal fixation in the elderly patients with lumbar degenerative disease

背景:脊柱内固定术后感染是骨科术后常见并发症,治疗方案仍存在争论。老年人腰椎退行性疾病日益增多,内固定术后感染处理无统一治疗方案。目的:探讨和分析老年人腰椎退行性疾病内固定术后切口感染的治疗效果。方法:对2012年1月至2015年1月首都医科大学附属北京世纪坛医院骨科收治并获得2年以上随访的老年腰椎退行性疾病内固定术后患者197例进行回顾性分析,随访时间2-4.9年。其中腰椎管狭窄97例,腰椎间盘突出29例,腰椎滑脱33例,退行性脊柱侧凸17例,腰椎椎体压缩性骨折21例。结果与结论:①197例腰椎退行性疾病内固定术后患者中,11例患者术后出现切口感染,其中10例切口急性感染,1例迟发性感染;②10例急性感染患者中,3例为切口表浅感染,7例为深部感染。急性感染的临床表现包括:切口渗液(10/10),切口局部疼痛(8/10),体温增高(9/10)。治疗方案包括给予细菌培养和药敏实验,同时静滴抗生素,感染局部清创引流冲洗,除了1例患者取出内固定,其余患者均未取出内固定;③迟发性感染患者只有1例,临床表现包括切口局部疼痛、切口渗液及间断性发热,取出内固定;④所有感染患者随访2年后,无假关节发生;(5)结果提示,老年腰椎退行性疾病内固定术后感染患者的治疗可考虑保留内固定物,静滴抗生素,感染区域清创引流冲洗,如果必要的话可反复清创感染区域。

BACKGROUND：With more and more elderly patients suffering lumbar degenerative disease undergoing internal fixation, infection after spinal internal fixation is a common complication in orthopedic surgeries, but its treatment strategy remains controversial.OBJECTIVE： To explore the curative efficacy of incision infection after internal fixation in the elderly with lumbar degenerative disease.METHODS： 197 patients with lumbar degenerative disease undergoing internal fixation and followed up for more than 2 years admitted in Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2012 to January 2015, were analyzed retrospectively. The follow-up time was 2-4.9 years. There were 97 cases of lumbar stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis and 21 cases of lumbar compression fractures.RESULTS AND CONCLUSION： （1） Eleven patients experienced incision infection, including ten acute, and one delayed infection. （2） Among acute infected cases, three were superficial infection in three cases and seven had deep infection,who characterized as exudation （10/10）, local pain （8/10） and fever （9/10）. Acute infected cases received bacterial culture, drug sensitive test, antibiotic therapy, and debridement of the infected wound, and leaving all internal fixators in situ in all but one case. （3） For delayed infection, one patient had local pain, incision exudation, and intermittent fever,and then the internal fixators were removed. （4） Pseudarthrosis was not founded during 2-year follow-up in all patients.（5） These results suggest that for the elderly patients suffering lumbar degenerative disease with infection after internal fixation, intravenous antibiotics, debridement plus drainage are recommended, but without internal fixator removal, and repetitive debridement and drainage is a rational choice if necessary.