胸腰椎脊柱后路椎弓根螺钉系统内固定术后深部伤口感染处理

Management of wound deep infection after spine posterior pedicel screw internal fixation

  • 摘要: 目的: 探讨胸腰椎脊柱后路椎弓根螺钉系统内固定术后深部伤口感染的诊断和处理方法。方法: 回顾性分析21例脊柱内固定术后深部伤口感染患者的治疗经过。术前行影像学检查,对于术后时间小于9个月,植骨未证实融合的患者采取伤口清创,置管冲洗引流;对于植骨已获得融合的患者行内置物取出、病灶清除、灌洗引流术,I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: 16例患者先行伤口清创,置管冲洗引流,11例患者深部感染获得治愈;其中5例于清创后的3~24个月再次发生深部感染,复查X线片,植骨均获得融合。10例植骨已获得融合的患者行内置物取出、病灶清除、灌洗引流术,I期关闭切口,深部感染获得痊愈。结论: 脊柱后路内固定术后伤口感染是一种严重的并发症,伤口清创,置管冲洗引流是一种有效的方法,可为早期感染植骨融合赢得时间;内固定取出为非必要条件。

     

    Abstract: Objective: To investigate the diagnosis and treatment of deep infection after posterior pedicel screw internal fixation. Methods: Retrospectively analysis the management of 21 cases of deep infection after posterior pedicel screw internal fixation. All cases given imageology pre-operation: cases were given debridement and irrigation-suction who post-operation time were less 9 months and bone graft didn’t fusion; cases were give removed implant and first stage sutured incisions who had been testified bone graft fusion. During operation, all spaceman conventional culture. All case were given intravenous antibiotic after operation. Results: 11 of 16 cases had wound healed after debridement and irrigation-suction. 5 cases recurred deep infection 3~24 months later, but X-ray confirmed bone graft fusion. 10 cases confirmed fusion and removed implant, debridement, irrigation-suction and first stage sutured incisions. All cases had wound healed. Conclusions: Deep wound infection is severe complication after spine internal fixation. Debridement and irrigation-suction is an effective method, at the same time, it can acquired time for bone fusion. Remove implant is not indispensable.

     

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