脊柱椎弓根螺钉系统内固定术后迟发性感染的处理

Management of delayed infection after spinal pedicle screw system fixation

目的研究脊柱椎弓根螺钉系统内固定术后迟发性感染的不同处理方法对患者的影响。方法从本院收治胸腰椎损伤需行脊柱椎弓根螺钉系统内固定术患者278例中选出术后迟发性感染患者60例纳为研究对象,依据处理方法不同,将其分为研究组(n=30,接受常规迟发性感染综合处理+人免疫球蛋白治疗)和对照组(n=30,接受常规迟发性感染综合处理),比较两组患者住院时间、留置管留置时间等一般情况以及治疗前后不同时间红细胞沉降率(ESR)及C-反应蛋白(CRP)。结果研究组患者住院天数(15.26±3.01)d、抗菌药物使用天数(13.20±2.33)d、留置管留置天数(3.09±0.53)d均低于对照组对应的(17.77±3.81)d、(15.65±3.42)d、(4.22±1.02)d,差异具有统计学意义(P<0.05);治疗后3 d、治疗后7 d,两组患者ESR水平均呈显著降低趋势(P<0.05),且研究组治疗后3 d、治疗后7 d的ESR水平均低于对照组对应水平(P<0.05);治疗后3 d、治疗后7 d,两组患者CRP水平均呈显著降低趋势(P<0.05),且研究组治疗后3 d、治疗后7 d的CRP水平均低于对照组对应水平(P<0.05)。结论在常规迟发性感染综合处理基础上给予人免疫球蛋白治疗,更能有效控制感染,提高治疗效果。

Objective To study the effect of different management methods of delayed infection after pedicle screw system fixation on patients.Methods Sixty patients with delayed infection were selected from 278 patients with thoracolumbar spine injury who were treated with pedicle screw system fixation.According to different treatment methods,60 patients were divided into study group(n=30).The patients in the two groups were treated with human immunoglobulin(hIg)and control group(n=30).The hospitalization time,the retention time and the erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)at different time points before and after treatment were compared between the two groups.Results The days of hospitalization(15.26±3.01)d,antibiotic use(13.20±2.33)d and indwelling tube(3.09±0.53)d in the study group were lower than those in the control group(17.77±3.81)d,(15.65±3.42)d,(4.22±1.02),the difference was statistically significant(P<0.05).The level of ESR in the study group was significantly lower than that in the control group(P<0.05),and the level of ESR in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0.05).The level of CRP in the study group was significantly lower than that in the control group at 3 days and 7 days after treatment(P<0.05),and the level of CRP in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0.05).Conclusion The treatment of human immunoglobulin on the basis of routine treatment of delayed infection can effectively control infection and improve the therapeutic effect.