摘要
背景:胸腰椎内固定术后手术部位感染是一种严重的并发症,对手术疗效起至关重要的作用。目的:探讨胸腰椎后路内固定术后伤口早期深部感染的临床特点。方法:回顾性分析2006年1月至2011年1月我院脊柱外科1100例胸腰椎后路内固定手术患者的临床资料。术后伤口早期感染患者65例,其中浅表感染40例,深部感染25例。深部感染患者中进行一次清创患者14例,多次清创患者11例;移除内固定患者9例,保留内固定患者16例。记录所有患者年龄、性别、BMI、病原菌种类、糖尿病、营养状况、激素使用、融合节段数、手术时间、出血量、异体输血及远处感染等情况。结果:与浅表感染患者相比,深部感染患者合并糖尿病及发生多重细菌感染的比率较高。多次清创患者中,耐甲氧西林金黄色葡萄球菌感染及远处感染的发生率高于一次清创者。内固定移除患者中,营养不足的比率高于内固定保留者。结论:深部感染患者常合并糖尿病及发生多重细菌感染,耐甲氧西林金黄色葡萄球菌感染及远处感染常需多次清创,营养不足可能是内固定保留失败的危险因素。
Background：Surgical site infection after thoracolumbar fixation is a serious complication, which can significant-ly affect clinical outcomes. Objective：To investigate the characteristics of early deep wound infection after posterior thora-columbar spinal fixation. Methods： Clinical data of 1100 patients who underwent posterior thoracolumbar fixation from Januray 2006 to January 2011 was analyzed retrospectively. Postoperative early wound infection developed in 65 patients of them. There were 40 cases with superficial infection and 25 with deep infection. Of the 25 cases with deep infection, 14 cas-es underwent debridement one time and 11 cases underwent multiple debridements;implants were preserved in 16 cases and removed in 9 cases. Age, sex, BMI, microbiological characteristics, diabetes mellitus, nutritional status, use of steroid hor-mone, fusion levels, surgical time, volume of boold loss, allogeneic transfusion and distant infection were evaluated. Re-sults：Patients with deep infection had higher incidences in comorbidities of diabetes mellitus and developing polymicrobial infection than those with superficial infection. Patients with multiple debridements had higher incidences in MRSA infec-tion and distant infection than those with single debridement. Patients with implant removal had a higher incidence of mal-nutrition than those with implant preservation. Conclusions： Patients with deep infection are most likely to have diabetes mellitus and develop polymicrobial infection. MRSA infection and distant infection are strong predictors for multiple de-bridements. Malnutrition may be a risk factor of implant removal.
出处
《中国骨与关节外科》
2016年第2期98-102,共5页
Chinese Journal of Bone and Joint Surgery
关键词
胸椎
腰椎
手术部位感染
Thoracic vertebrae
Lumbar vertebrae
Surgical site infection
