摘要
目的调查分析脊柱内固定术后伤口发生细菌感染的临床诊断以及保留内置物的治疗方法,降低脊柱内固定术后感染率。方法选取2009年1月-2013年7月收治的脊柱内固定术后感染的28例患者作为观察组,同时随机选取同时期行脊柱内固定术后未发生感染的28例患者作为对照组,通过与对照组的临床资料对比,分析细菌感染发生的原因,采用保留内置物手术治疗的方法,对感染进行有效清除。结果观察组患者的平均年龄、手术时间、术中出血量及并发症发生率,分别为(53.9±5.8)岁、(264.2±20.8)min、(575.0±42.0)ml及71.4%,均高于对照组的(45.7±6.3)岁、(157.87±17.9)min、(240.0±37.0)ml及42.8%,差异有统计学意义(P<0.05);感染患者以急性感染多见,其细菌培养结果以金黄色葡萄球菌为主占65.20%,迟发感染则以少数存在,其细菌培养类型以表皮葡萄球菌为主占80.00%;通过内置物保留手术治疗后,所有急性感染患者的体温、白细胞计数、中性粒细胞所占比例、血沉系数以及C-反应蛋白含量均基本恢复正常,与治疗前相比差异有统计学意义(P<0.05),有1例迟发感染患者治疗后复发,效果差。结论脊柱内固定术的手术方式、手术时间、术中出血量和患者年龄及有无并发症,影响术后感染的发生,应给予重视;通过内置物保留治疗可以有效清除急性感染症状,可以推荐采取内置物保留治疗,但对迟发感染患者需慎重考虑治疗方案,防止复发。
OBJECTIVE To investigate the clinical diagnosis of bacterial infections after spinal internal fixation and treatment of implant retention ,so as to reduce infection rates after spinal internal fixation .METHODS Totally 28 patients with infections after spinal internal fixation admitted during Jan .2009 - Jul .2013 were set as the observation group ,meanwhile 28 patients who had no infections after spinal internal fixation during the same peri‐od were randomly selected as the control group .The causes of bacterial infections were analyzed by comparing clinical data between the two groups ,and implant retention treatment was used to effectively remove infections . RESULTS The mean age ,operation time ,perioperative bleeding amount and incidence of complications was （53 .9 ± 5 .8） years ,（264 .2 ± 20 .8） min ,（575 .0 ± 42 .0） ml ,and 71 .4% in the observation group ,significantly higher than （45 .7 ± 6 .3） years ,（157 .87 ± 17 .9）min ,（240 .0 ± 37 .0）ml ,and 42 .8% in the control group （P〈0 .05） . Acute infection was commonly seen in infected patients and the result of bacterial culture showed that Staphylo‐coccus aureus was the most common （65 .20% ） .Late infections occurred in a few patients and the type of bacteria in this infection was mainly S .epidermidis （80 .00% ） .By implant retention treatment ,body temperature ,leuko‐cyte count ,percentage of neutrophils ,erythrocyte sedimentation rate and C‐reactive protein factor levels were re‐turned to normal in all patients ,with significance compared with pre‐treatment status （P 〈0 .05） .One case had recurrence of late infections after treatment ,indicating the efficacy was poor in this case .CONCLUSION Operative approach ,operation time ,perioperative bleeding amount ,patient age and complications of spinal internal fixation influence the incidence of postoperative infection ,which should be emphasized .It is recommended to take implant retention treatment as it can effectively remove symptoms of acute infection ,however ,it should be implemented with caution in patients with late infections to prevent recurrence .
出处
《中华医院感染学杂志》
CAS
CSCD
北大核心
2015年第12期2831-2833,共3页
Chinese Journal of Nosocomiology
基金
河南省卫生厅科技基金资助项目(HW-2010B024)
关键词
脊柱内固定术
细菌感染
保留内置物
Spinal internal fixation
Bacterial infection
Implant retention
