摘要
探讨脊柱后路内固定术后迟发性感染的发生原因和有效治疗方法。方法 :12例患者分别在术前和术中窦道分泌物取样行细菌培养 ,培养时间为 7d以上。 3例先行抗炎、窦道搔刮或切开清理、置管冲洗引流 ,均未见效而改行内固定物取出术。另 9例在明确诊断后即行积极的内固定物取出术。术中仔细观察软组织和骨质的变化 ,术后抗炎。结果 :7例细菌培养阳性。 3例为微球菌 ,4例为粪链球菌。另 5例为阴性。术前和术中 2次取样培养结果一致。 3例先行保守治疗者改行内固定物取出术后伤口及窦道顺利愈合 ,平均住院时间 4 0d。另 9例在明确诊断后即行内固定物取出术 ,术后伤口及窦道顺利愈合 ,平均住院时间 14d。术后抗生素的应用时间为 12～ 14d。随访 3～ 12个月感染无复发。术中发现 9例窦道与椎弓根螺钉尾部相通 ,原发病灶仅为在该处的局限性肉芽病灶、有少许脓块 ,该钉尾的固定螺帽有松动。病灶不向深处累及椎弓根和椎板 ,椎弓根钉本身无松动 ;另 3例窦道与横向连接杆的一端相通 ,原发病灶亦为一小的局限肉芽组织团块。结论 :脊柱后路内固定术后发生的迟发性感染通常是由低毒性细菌引起的局部软组织感染 ,骨质未受侵蚀 ,对这一感染引起的窦道、流脓采取抗炎、局部处理效果差 ,而积极的内固定物取出术是有效的控制?
Objective:To explore the treatment and etiology of late-developing infection after posterior spinal internal fixation.Methods:Bacterial cultures were taken twice for each case preoperatively and interoperatively,and the culture duration was more than seven days.Three of the twelve cases were treated initially with conservative method, such as antibiotics,debridment of sinus, irrigation and drainage of sinus, but internal device removal was used owing to no effectiveness of the conservative method. The other nine cases were treated directly with positive bone change was made for each case during operation.Results:The bacterial culture results showed that 3 cases were micrococcus, and four cases were stecorous-streptococcus, the other 5 cases were negative. The first 3 cases were treated with conservative method initially and then had to convert to operation of device removal,and the average hospital stay was 40 days. The other 9 cases were treated with internal device removal,and the average hospital stay was 14 days.All the wounds and sinus healed uneventfully. The duration of antibiotics use after device removal was 12～14 days.No case was recurrent during the follow-up time of 3～12 months. We found the sinus led to one pedicle screw end in 7 cases and to one end of device of transverse tract (DTT) in 3 cases;the original focui were local granulomatous,with a little amount of pus;the focui did not involved pedicles and lamina, and the pedicle screws were not loose.Conclusions:Late-appearing infection in posterior spinal instrumentation is caused by low virulence organisms,and the infections affect only soft tissue,not the bone. The most effective method to control the infection is postive internal device removal.
出处
《中国现代医学杂志》
CAS
CSCD
2002年第15期22-24,共3页
China Journal of Modern Medicine
关键词
术后
脊柱后路内固定术
迟发性感染
细菌学
治疗
Posterior Spinal Instrumentation
Late-developing Infection
Bacteriology
Treatment
