腰椎后路内固定术后感染的原因分析与治疗体会
黄帅豪;柯雨洪;王义生;肖丹;昌耘冰;
摘要(Abstract)：
[目的]探讨腰椎疾患后路内固定术后感染的危险因素及诊疗措施。[方法]2009年7月~2012年7月,本组共468例患者因腰椎疾患接受腰椎后路内固定术。其中13例手术后并发深部感染,给予切开引流,彻底清创及内固定取出、灌洗引流术,辅以敏感抗生素静脉滴注。对临床疗效及手术时间、术中失血量、围手术期抗生素的使用、临床表现、实验室检查、细菌培养等进行回顾性分析。[结果]本组病例术后感染率为2.78%。13例患者出院时伤口均一期愈合,无脊髓神经损害。平均随访13个月(8~15个月),未发现感染复发。手术时间90 min以内、90~120 min、>120 min,术后感染发生率分别为0.88%(2/226)、2.33%(4/172)、10.00%(7/70)。术中失血量50~300 ml、300~600 ml和600 ml以上术后感染发生率分别为0.89%(2/225)、2.84%(5/176)、10.52%(6/57)。术后使用抗生素72、48、24 h感染发生率分别为0.75%、3.29%、11.70%。[结论]腰椎后路内固定术后感染与手术时间、术中失血量有关,手术失血量越多,手术时间越长,术后越易发生感染,围手术期使用抗生素可有效减少感染的发生;确诊后病灶清除、内固定物取出、灌洗引流、静脉应用有效抗生素,可获得满意疗效。
关键词(KeyWords)： 腰椎手术;内固定术;感染;原因;治疗
基金项目(Foundation): 广东省科技计划项目(编号:2011B031800366);; 广东省人民医院院级课题(编号:Y012011269)
作者(Author): 黄帅豪;柯雨洪;王义生;肖丹;昌耘冰;
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