腰椎术后手术部位深部感染的诊断与治疗

Diagnosis and treatment of deep surgical site infection after lumbar surgery

目的 :探讨腰椎术后手术部位深部感染的诊断与治疗方法。方法 :回顾性分析2012年1月~2017年7月我院骨科收治的14例腰椎术后深部感染患者的临床资料、诊疗方法、随访结果。其中男性9例,女性5例,平均年龄53.0±13.1岁(19~73岁);早期感染(<30d)13例,迟发感染(≥30d)1例;应用内固定物13例,未应用内固定物1例。患者出现感染征象后,立即留取标本送检并经验性静脉应用抗生素,随后根据细菌培养结果与病情变化调整抗生素种类,待主要炎症指标正常后改为口服抗生素。12例单纯抗生素治疗后病情未见改善者,予全麻下彻底清创;其中4例清创术后采用对口持续灌洗引流,另8例清创术后采用VSD负压引流,随访观察治疗效果。结果:本组共7例患者细菌培养结果阳性,其中单一细菌感染6例,混合感染1例。所有患者均应用抗生素治疗;静脉抗生素使用时间平均39.7±13.2d(24~77d),口服抗生素使用时间平均32.9±3.1d(28~38d)。13例内固定置入术后感染患者中11例内固定物得以保留,2例因多次清创无效后移除部分内固定物。14例患者均逐渐好转、最终治愈出院,平均住院时间51.4±13.1d。所有患者经平均32.4±18.6个月(4~67个月)随访,至末次随访时未见感染复发,且均主诉满意。结论:抗生素治疗、外科彻底清创是腰椎术后深部感染的有效治疗手段;对于有内固定物者,早期感染获得积极治疗后可保留内固定。

Objectives： To investigate the clinical characteristics and the treatment strategy of deep surgical site infection after lumbar operation. Methods： Fourteen cases of deep surgical site infection after lumbar surgery were analyzed retrospectively between January 2012 and July 2017. There were 9 males and 5 females with a mean age of 53.0±13.1 years. 3 cases were from our hospital, and 11 cases were transferred from other hospitals. There were 13 early infections and 1 delayed infection. There were 13 cases with internal fixation and 1 case without internal fixation in the primary surgeries. After the symptoms of infection occurred, specimens were taken for bacterial cultures and antibiotic susceptibility tests. Simultaneously, patients were empirically administered intravenously. Then, the antibiotics were adjusted according to the results of bacterial cultures and the changes of patients′ conditions. After the main inflammatory indicators were normal, intravenous antibiotics were replaced by oral antibiotics. 12 cases who did not improve their condition after antibiotic treatment were completely debrided under general anesthesia： 4 cases were treated by continuous irrigation and drainage after debridement; the other 8 cases received debridement and vacuum sealing drainage（VSD）. Results： Total 7 patients were positive for bacterial culture, including 6 cases of single bacterial infection and 1 case of mixed infection. All patients were administered antibiotics with an average of 39.7±13.2d（24-77d） for intravenous antibiotics and 32.9±3.1d（28-38d） for oral antibiotics. Among the 13 patients with infection after internal fixation, the implants of 11 cases were retained and 2 cases were removed after multiple debridement. The average length of hospital stay was 51.4±13.1 days. All the deep infections were controlled and patients achieved an average of 32.4±18.6 months（4-67 months） followed-up. No recurrence of infection was found at final follow-up. Conclusions： Antibiotics and surgical debridement are effective treatments for deep surgical site infection after lumbar surgery. For patients with early infection, active treatments can prevent removal of implants.