摘要
目的分析轴形内固定(atlasfixator,AF)术后迟发感染的危险因素和临床表现,探讨其有效的治疗方法。方法对AF内固定术后并发迟发感染的8例患者的临床表现、实验室检查、细菌培养等进行回顾性分析。所有患者都再次手术行内置物取出、病灶清除、灌洗引流术,一期关闭切口,术中取标本作常规培养,术后静脉应用抗生素。结果8例患者在初次手术后10～27个月出现症状,平均为18个月。迟发感染症状多不典型,但所有患者均主诉腰部疼痛,且有窦道形成。白细胞均未升高,6例血沉升高。二次术后所有患者疼痛消失,切口一期愈合。4例培养出低毒力性皮肤正常菌群。结论AF内固定术后迟发感染是由初次手术时术中污染引起的椎旁深部软组织感染,但未累及骨组织。确诊后行内固定取出、病灶清除、灌洗引流术,疗效满意。
Objective To study the clinical presentations,risk factors of delayed infection a fter AF internal fixation and find out an eff ective treatment for this complication.Methods Eight cases of delayed infection following AF internal fix ation were reviewed.Clinical sympt oms,laboratory tests and culture re ports were studied.All patients were treated with debridement,instrumentation removal and irrigation.The woun d was primary closed followed by posto perative administration of antibio tics.The specimen obtained in the op-eration was sent to bacteria culture.Results These 8patients experienced develo pment of late infection in10-27months(a mean of 18months)after the initial procedure.The cli nical presentations were variable b ut all patients reported back pain and t he development of draining sinus.Si x patients had elevated erythrocyte sedimentation rate.None had elevated white blood cell counts.After re-operation,all patients gained reli ef of back pain and the wounds were healed u p.Low-virulence skin normal organi sms were yielded in 4cases with general culture.Conclusion These late infections after AF internal fixation may have been caused by i n-traoperative contamination.The in fection affect deep soft tissue with out involving the bone.It can be suc-cessfully treated with debridement ,device removal and irrigation,primary skin closure and short-term an-tibiotics.[
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2002年第6期340-342,共3页
Chinese Journal of Orthopaedics
关键词
内固定器
脊柱骨折
手术后并发症
感染
Internal fixators
Spinal fracture s
Postoperative complications
In fection
