腰椎后路内固定融合术术后早期切口深部感染的治疗分析

Analysis of the Treatment of Early Incision Deep Infection after Posterior Lumbar Internal Fixation and Fusion

目的:探讨腰椎后路内固定融合术术后早期切口深部感染的风险因素及治疗方法。方法:回顾性分析云南省第一人民医院骨科2010年1月至2018年12月行腰椎后路内固定融合术患者的病例资料,对所有患者进行感染风险因素评估(RFS),根据是否发生感染的情况将患者分为非感染组(n=1481)和感染组(n=11),感染组患者行彻底清创、闭式冲洗引流及抗菌药物治疗。结果:两组患者RFS差异有统计学意义(P<0.05)。感染组患者经过清创、闭式冲洗引流及抗菌药物治疗后治愈6例,切口感染并发颅内感染死亡1例,反复清创、闭式冲洗及抗菌药物治疗取出内固定器感染治愈4例。结论:腰椎后路内固定融合术术后早期切口感染发生率较低,彻底清创、闭式冲洗引流及抗菌药物治疗可治愈感染;长期口服激素且RFS>3分的患者需彻底清创后取出内固定器。

Objective:To investigate the risk factors and treatment methods of early incision deep infection after posterior lumbar internal fixation and fusion.Methods:The case data of patients undergoing posterior lumbar internal fixation and fusion in the Department of Orthopedics of the First People’s Hospital of Yunnan Province from January 2010 to December 2018 were retrospectively analyzed,and all patients were assessed for risk factors for infection(RFS).The patients were divided into noninfection group(n=1481)and infection group(n=11)according to whether or not patients have an infection.The patients in the infection group were treated with thorough debridement,closed irrigation and drainage,and antibiotics.Results:The difference in RFS between the two groups was statistically significant(P<0.05).In the infection group,6 cases were cured after debridement,closed irrigation and drainage and antibiotic treatment,1 case died of incision infection complicated with intracranial infection,and4 cases were cured of infection after repeated debridement,closed irrigation and antibiotic treatment to remove internal fixator.Conclusion:The incidence of early incision infection after posterior lumbar internal fixation and fusion is low,and thorough debridement,closed irrigation and drainage and antibiotic therapy can cure infection;the internal fixator should be removed after thorough debridement for patients with long-term oral corticosteroids and RFS>3 points.