CAJ | 학술논문

目的：探讨腰椎后路融合内固定术后早期深部感染的发生率、影响因素及治疗策略。方法回顾性分析我院2003-2011年1492例行腰椎后路融合内固定术患者术后早期深部感染的发生率，根据是否发生感染将患者分为两组：感染组11例，非感染组1481例，进行感染风险因素评分（infection risk factor score，RFS），比较两组是否存在统计学差异，分析保留内置物情况下彻底清创、持续冲洗负压引流结合静脉滴注抗菌药物治疗的成功率、分析失败因素及处理策略，探讨何种状况下需清创同期取出内固定。结果1492例腰椎后路融合内固定术后早期深部切口感染11例（0．74％），感染组与非感染组 RFS分别为2．64±0．24和0．78±0．55，差异有统计学意义（P ＝0．032）。9例保留内置物情况下采用彻底清创、持续冲洗负压引流，结合静脉滴注抗菌药物，治疗成功6例。另3例2次清创取出内固定后继续冲洗引流：2例感染彻底控制、1例伤口愈合后1个月血液感染继发颅内感染、感染性休克死亡；2例术前长期口服激素同时 RFS≥3分患者，采用彻底清创、持续冲洗负压引流，结合静脉滴注抗菌药物同时取出内固定，感染彻底控制。结论腰椎后路融合内固定术后早期深部感染发生率相对较低，保留内置物情况下彻底清创后持续冲洗负压引流结合静脉滴注应用抗菌药物是一种有效的治疗方法，对于术前长期口服激素同时 RFS≥3分患者，彻底清创同时取出内固定有利于感染彻底控制。
목적：탐토요추후로융합내고정술후조기심부감염적발생솔、영향인소급치료책략。방법회고성분석아원2003-2011년1492례행요추후로융합내고정술환자술후조기심부감염적발생솔，근거시부발생감염장환자분위량조：감염조11례，비감염조1481례，진행감염풍험인소평분（infection risk factor score，RFS），비교량조시부존재통계학차이，분석보류내치물정황하철저청창、지속충세부압인류결합정맥적주항균약물치료적성공솔、분석실패인소급처리책략，탐토하충상황하수청창동기취출내고정。결과1492례요추후로융합내고정술후조기심부절구감염11례（0．74％），감염조여비감염조 RFS분별위2．64±0．24화0．78±0．55，차이유통계학의의（P ＝0．032）。9례보류내치물정황하채용철저청창、지속충세부압인류，결합정맥적주항균약물，치료성공6례。령3례2차청창취출내고정후계속충세인류：2례감염철저공제、1례상구유합후1개월혈액감염계발로내감염、감염성휴극사망；2례술전장기구복격소동시 RFS≥3분환자，채용철저청창、지속충세부압인류，결합정맥적주항균약물동시취출내고정，감염철저공제。결론요추후로융합내고정술후조기심부감염발생솔상대교저，보류내치물정황하철저청창후지속충세부압인류결합정맥적주응용항균약물시일충유효적치료방법，대우술전장기구복격소동시 RFS≥3분환자，철저청창동시취출내고정유리우감염철저공제。
Objective To evaluate the incidence,related risk factors and treatment strategy of the early deep infections following instrumented lumbar posterior spinal fusion.Methods A total of 1 492 consecutive patients who underwent instrumented lum-bar posterior spinal fusion procedure at our hospital from 2003 to 2011 were retrospectively reviewed.The incidence of early deep infection was calculated.Each patient was assigned an infection risk factor score (RFS)depending on the number of RFS indentified in that patient preoperatively.The mean RFS was compared between the patients who developed early deep infection and those without infection.The outcome of continuous irrigation-suction combined with intravenous antibiotic therapy plus wound debridement and retention of implants was assessed to identify the most appropriate conditions for removing the implant during initial wound debridement.Results Early deep infection occurred in 11 out of the 1 492 patients (0.74%).The mean RFS was 2.64±0.24 for the patients who developed infections and 0.78±0.55 for the patients without infection (P =0.032). The infection was eradicated completely in 6 of the 9 patients who were managed by continuous irrigation-suction combined with intravenous antibiotic therapy plus wound debridement and retention of implants.The other 3 patients who had persistent wound discharge received second debridement and removal of implants,which resulted in infection free in 2 patients and death due to septic shock 1 month after wound healing in 1 patient. The infection was successfully treated in the 2 patients who had prior long-term use of corticosteroids and RFS ≥ 3 by complete debridement in combination with continuous irriga-tion-suction drainage,intravenous antibiotic therapy and re-moval of implant during initial wound debridement.Conclusions The incidence of early deep infection following instrumented lumbar posterior spinal fusion is relatively low.Continuous irrigation-suction drainage combined with intravenous antibiotic ther-apy plus wound debridement and retention of implants is a relatively effective method for management of the early deep infections following instrumented lumbar posterior spinal fusion.For the patients who have prior long-term use of cortocosteroids and RFS≥ 3,removal of implant during initial wound debridement may be better for infection control.