脊柱内固定术后感染与危险因素分析及对策.docVIP

脊柱内固定术后感染的危险因素分析及对策 朱军、殷翔、范伟力、柳峰、刘鹏、赵建华 （第三军医大学第三附属医院脊柱外科，400042，重庆） 摘??要：［目的］探讨脊柱内固定术后感染的危险因素及对策。［方法］回顾性分析2012年1月至12月我科472例行脊柱内固定手术患者的病例资料，分析术后伤口感染相关危险因素及对策。［结果］472例患者术后感染共9例，发生率1.91％（9/472），平均年龄50.6岁（38～78岁），均为脊柱后路手术。平均手术时间170mins（100～325mins）；平均术中失血量556ml（ 200～1500ml）；平均术后引流量425ml（ 65～1350ml），大多比同期同类手术明显增加。伤口感染初始征象出现时间为术后10d（6～16d）。白细胞总数、血沉及CRP在术后4～7d明显升高，且维持在高位水平14d以上。细菌培养显示致病菌主要为常见皮肤菌群。本组感染患者均接受伤口清创引流手术，未取出内固定及植骨，术后使用敏感抗生素，随访8～19个月（平均11个月），除1例复发（再次使用敏感抗生素治愈）外，其余无临床感染复发征象。［结论］脊柱术后伤口感染主要发生于后路开放性手术，均为深部感染；术中、术后出血总量大、手术时间长是造成围手术期营养状况差及感染的危险因素。其临床特征是伤口渗液和局部深压痛，发热及切口表面红肿相对少见；及时清创引流、一期缝合伤口及应用敏感抗生素，可取得良好效果；清创手术不必常规取出内固定物及植骨。 关键词：脊柱手术；?感染；清创 Risk factors and treatment for wound infections after spinal internal fixation Zhu Jun，Yin Xiang，Fan Weili，Liu Feng，Liu Peng，Zhao Jianhua(Department of Spinal Surgery, Third Affiliated Hospital, Third Military Medical University， Chongqing 400042，China Objective To investigate the risk factors?and treatment for infections after spinal internal fixation surgery. Methods ?The?clinical?data of 472 patients?who underwent spinal internal fixation surgery from Jan. to Dec. 2012 was analyzed?retrospectively. Risk factors and treatment for infections were summarized and discussed. Rresults?Of 472 patients, postoperative infections occurred in 9 cases with the infection rate of 1.91%, and an average age of 50.6 years?(38?~ 78 years). All cases were underwent?posterior procedures.?The average operation time, intraoperative blood and postoperative drainage was 170mins?(100 ~ 325mins), 556ml?(200 ~ 1500ml) and?425ml?(65 ~ 1350ml)， which were greater than the similar surgeries of same period.?The initial?signs?of wound infection?was?observed at?10days (6 ~ 16 d) after surgery.?CRP,?ESR and?WBC?were significantly increased in?4 ~ 7d after surgery,?and?maintained at?high level at least for 14 days. Bacterial culture?results showed?infection?bacteria were mainly common?skin flora. All patients received?emergency operation of?wound?debridement, dra