摘要
目的 探讨脊柱椎弓根螺钉系统内固定术后迟发性感染的处理方法。方法 对 16例椎弓根螺钉系统内固定术后并发迟发性感染的患者 ,均采用病灶清除、灌洗引流 ,其中 14例同时取出内固定物 ,2例因骨折尚未愈合 ,内固定物予以保留 ,术后静脉应用头孢类抗生素 14～ 2 1天。结果 16例中 14例已取出内固定物的患者窦道、切口甲级愈合 ,疼痛减轻或消失 ,术后 14天ESR、CRP降至正常。 2例未行内固定物取出者 ,拔除引流管后 15天～ 1个月 ,患处再次出现疼痛、肿胀及硬块 ,第 2次施行病灶清除、内固定物取出、灌洗引流、静脉应用头孢类抗生素 3周后 ,伤口愈合、疼痛、肿胀消失出院。 16例患者术后随访 12～ 2 5个月 ,平均 16个月 ,均无复发征象。结论 迟发性感染是由初次手术时术中污染引起的椎旁深部软组织的感染 ,确诊后行病灶清除、内固定物取出、灌洗引流、静脉应用有效抗生素 。
Objective To improve the treatment of delayed infection after spinal internal fixation by pedicle of vertebral arch screw. Methods 16 patients were affected by delayed infection after spinal internal fixation by pedicle of vertebral arch screw. All patients underwent debridement and lavage. Among them, internal fixator were removed in 14 and kept in place in two as a result of failed fracture healing. Antibiotics were administrated venously in all patients for about 14 to 21 days after operation. Results After debridement and internal fixator removal, 14 patients experienced sinus and wound healing, and pain palliation meanwhile. ESR and CRP were decreased to normal status 14 days after surgery. The other 2 patients had painful, focus with swelling and hard lump 15 days to 1 mouth after initial debridement. In the following second operation, these 2 patients had repeated debridement, internal fixator removal and lavage, also antibiotics were used venously. 3 weeks after surgery, 2 patients discharged with wound healing and swelling disappearing. All these 16 patients were followed up for 12～25 months and no complication was recorded. Conclusion Delayed infections may be caused by contamination during initial operation. If diagnosis confirmed, operative procedure should be carried out. The surgical procedures should include debridement, internal fixator removal, lavage and antibiotics administration.
出处
《临床骨科杂志》
2001年第3期184-186,共3页
Journal of Clinical Orthopaedics
