胸腰椎骨折前路术后感染的治疗.docVIP

经后路椎弓根螺钉固定治疗脊柱前路术后感染 刘玉武 张正丰 （浙江省江山市人民医院骨科，324100） 【摘要】目的：探讨脊柱前路术后并发切口深部感染的外科治疗措施。方法：31列患者脊柱前路术后切口深部感染的患者均行前路内植物取出、清创、植骨融合联合后路椎弓根螺钉固定手术，术后给予抗生素治疗、早期下床活动等治疗措施，同时术后给予拍片复查及ESR、CRP试验室检查。结果：31例患者取出内植物后疼痛消失，术后体温及ESR、CRP均正常，患者术后感染无复发, 切口与窦道均愈合。术后6-18个月复查X线未见骨折复位高度及脊柱纠正角度丢失，植骨均融合。结论：通过前路取出内固定，可以彻底清除感染组织，达到根治感染的目的。后路内固定可以避免椎间高度和（或）脊柱纠正角度丢失，同时恢复了脊柱的稳定性，病人可以早起下床活动，减少住院时间及住院费用。 【关键词】脊柱前路术后；切口深部感染；前路内植物取出；后路椎弓根螺钉固定。 [Abstract] Objective: To investigate the pedicle screw fixation with minimally invasive technique combined with impanlt removal via anterolateral approach for spinal deep wound infection.Methods: 31 patients with deep wound infection underwent spine fusion with implant via anterolateral approach were performed implant removal via anterolateral approach, wide debridement, bone graft and pedicle screw fixation with minimally invasive technique via posterior approach. Of all patients administrated antibiotic therapy according to the results of drug sensitivity after operation .At the same time, other treament were performed as follow: early ambulation, radiographs, ESR and CRP laboratory examination performed postoperatively. Results: the pain disappeared in 31 patients after implant removal, body temperature and ESR, CRP restored to normal level after operation, the deep wound infection no recurrence, incision and sinus healing well. 6-18 months after operation, X-ray showed no reduction of the fracture height and spinal corrective angle loss, bone fusion satisfied. Conclusion: the pedicle screw fixation with minimally invasive technique combined with impanlt removal via anterolateral approach can cure spinal deep wound infection exhaustively and restore stability of the spine to avoid the intervertebral height and (or) spinal corrective angle loss, the stability of spine also contribute to early ambulation and reduce hospitalization time and hospitalization expenses [keywords] Anterior approach of spinal surgery; Deep wound infection; implant