腰椎术后切口积液的探讨Study of postoperative incisal effusion following posterior lumbar spinal surgery
胡飞;尚希福;孔荣;方诗元;童元;
摘要(Abstract):
[目的]分析后侧入路腰椎术后切口积液产生的原因,探讨积液的分型并确定相应的治疗策略。[方法]自2001年6月~2006年6月本院共开展1986例经后侧入路的腰椎手术。使用内固定的手术877例,未使用内固定手术1109例,比较两组间切口积液的发生率。将发生积液的病人分为Ⅲ型:Ⅰ型:病因明确型,共28例;Ⅱ型:感染型,共11例;Ⅲ型:病因不明确型,共14例。Ⅰ型病人给予穿刺抽液,对因治疗,营养疗法。Ⅱ型病人给予穿刺抽液,清创,手术灌洗和按药敏给予抗生菌治疗。Ⅲ型病人给予穿刺和预防应用抗生素。[结果]使用内固定组的切口积液率(4·33%)高于未使用内固定组(1·35%)P<0·01。平均住院日:Ⅰ型14·7d,Ⅱ型:87·6d,Ⅲ型:15·6d。[结论]伴随手术过程的复杂化切口积液率明显增高。给积液分型有助于确定有效的治疗方案。Ⅰ型病人予以穿刺抽液和对因治疗。Ⅲ型治疗的关键是防止转化为Ⅱ型。Ⅱ型治疗比较困难,积极的手术干预和按药敏给予抗生菌是两个关键的治疗方法。
关键词(KeyWords): 腰椎手术;术后并发症;切口积液;感染
基金项目(Foundation):
作者(Author): 胡飞;尚希福;孔荣;方诗元;童元;
Email:
DOI:
参考文献(References):
- [1][J].
- [1]Brown MD,Brookfield KF.A randomized study of closed wound suc-tion drainage for extensive Lumbar spine surgery[J].Spine,2004,29(10):1066-1068.
- [2]Scuderi GJ,Brusovanik GV,Fitzhenryl N,et al.Is wound drainage necessary after lumbar spinal fusion surgery[J].Med Sci Monit,2005,11(2):64-66.
- [3]闫传柱.下腰椎围手术期并发症[J].中国矫形外科杂志,2005,13(7):515-517.
- [4]Weinstein MA,Mc Cabe JP,Cammisa FP,et al.Postoperative spi-nal wound infection:a review of2391consecutive index procedures[J].Spinal Discord,2000,13(5):422-426.
- [5]Kuo CH,Wang ST,Yu WK,et al.Postoperative spinal deep wound infection:a six-year review of3230selection procedure[J].Chin Med Assoc,2004,67(8):398-402.
- [6]Fang A,Huss,Endres N,et al.Risk factors for infection after spi-nal surgery[J].Spine,2005,30(12):1460-1465.
- [7]Massie JB,Heller JG,Abitbol JJ,et al.Postoperative posterior spi-nal wound infections[J].Clin Orthop Relat Res,1992,(284):99-108.
- [8]Mehbod AA,Ogilvie JW,Pinto MR,et al.Postoperative deep wund infections in adults after spinal fusion:management with vacu-um-assisted wound closure[J].Spinal Disord Tech,2005,18(1)14-17.
- [9]Schmidt AH,Swiontkowski MF.Pathophysiology of infections after internal fixation of fractures[J].AM Acad Orthop Surg,2000,8(5):285-291.
- [10]Thewesc M,Kretschmer R,Gfesser M,et al.Immunohisto chemi-cal characterization of the perivascular infiltrate cells in tissues adja-cent to stainless steel implants'compared with titanium implants[J].Arch Orthop Traume Surg,2001,121(4):223-226.