持续闭式冲洗引流治疗脊柱后路内固定植骨融合术后切口深部感染的体会

摘要

目的总结持续闭式冲洗引流治疗脊柱后路内固定、植骨融合术后切口深部感染的体会。方法回顾性分析2007年1月~2012年5月脊柱内固定、自体骨或异体骨植骨融合术后切口深部感染26例患者的临床资料。临床表现主要为切口脓性分泌物、体温升高和局部疼痛等，血液学及细菌学检查确定有无细菌性感染；所有患者在诊断切口深部感染明确后，全部行切口拆开，清创，闭式冲洗引流联合敏感抗生素的治疗。结果随访4个月~3年，平均2.1年。闭式冲洗引流后7日局部症状消失，引流液清亮后拔管4例，7~14日拔管13例，14~21日拔管9例；引流后21日，全身症状消失、血常规、CRP、血沉正常后停用抗生素13例，36日停用抗生素13例。5例形成慢性窦道，经久不愈，1年后取出内固定后愈合。所有患者在随访期间未见断钉与断棒。结论联合敏感抗生素加闭式冲洗引流治疗脊柱后路内固定融合术后切口深部感染有利于及时控制感染，疗效肯定且没有必要取出内固定物及植骨材料。%Objective To summarize the experiences of continuous closed irrigation and drainage in the treatment of deep incision-al wound infections after spinal posterior internal fixation and bone graft fusion. Methods A retrospective analysis was made in the clinical data of 26 patients with deep incisional wound infections after spinal posterior internal fixation and autogenous or allogeneic bone graft fusion between January 2007 and May 2012. The main clinical manifestations included purulent wound secretion, ferves-cence, and local pain, etc. Hematologic and bacteriologic examinations were carried out to determine whether there was bacterial infec-tion. All patients received the opening of the wound, debridement, and closed irrigation and drainage combined with sensitive antibiotics therapy after the diagnosis of deep incisional wound. Results The following-up lasted from 4 months to 3 years with an average time of 2.1 years. The local symptoms disappeared 7 d after the closed irrigation and drainage. Extubation was carried out after the drainage fluid became clear in 4 cases, 7 to 14 days after the irrigation in 13 ones, and 14 to 21 days in 9 ones. The general symptoms disappeared 21 d after the drainage. In 13 cases, the use of antibiotics was stopped in 21 d after the disappearance of general symptoms and the nor-mality of blood routine, CRP, and erythrocyte sedimentation rate, and that was stopped in 13 ones on day 36. In 5 cases, chronic sinus tracts were formed and healed 1 year after the internal fixation had been removed. Screw and stick breakage did not occur in all the cas-es during the following-up. Conclusion Combination of sensitive antibiotics therapy with closed irrigation and drainage has certain cu-rative effect on deep incisional wound infection after spinal posterior internal fixation and bone graft fusion. It can control the infection in time, and there is no need to remove the internal fixation and bone graft materials.