CAJ | 학술논문

目的：分析脊柱后路手术后早期切口感染的病原菌，观察不同处理方法治疗并发症的临床效果。方法回顾性分析30例脊柱后路手术早期切口感染患者，其中表浅感染7例，深部感染23例，分析患者的临床表现、诊断、治疗、病原学、药敏试验及随访结果。结果30例患者感染时间为术后2～15 d，共分离出菌株33株，其中革兰阳性球菌18株（54.5%），以金黄色葡萄球菌多见（13株，39.4%）；革兰阴性杆菌15株（45.5%），以大肠杆菌居多（6株，18.2%）。药敏试验提示革兰阳性球菌对万古霉素、利福平、替考拉宁、复方新诺明敏感性高，未发现对万古霉素耐药的金黄色葡萄球菌；革兰阴性菌对亚胺培南敏感性较高(100%)。7例表浅感染者经换药后治愈；23例深部感染者经伤口彻底清创，置管冲洗引流，且均保留内固定，亦未见感染复发。结论脊柱后路术后早期切口感染病原菌多为金黄色葡萄球菌，对于深部感染者，应早期扩创、持续灌注冲洗引流并使用万古霉素。
목적：분석척주후로수술후조기절구감염적병원균，관찰불동처리방법치료병발증적림상효과。방법회고성분석30례척주후로수술조기절구감염환자，기중표천감염7례，심부감염23례，분석환자적림상표현、진단、치료、병원학、약민시험급수방결과。결과30례환자감염시간위술후2～15 d，공분리출균주33주，기중혁란양성구균18주（54.5%），이금황색포도구균다견（13주，39.4%）；혁란음성간균15주（45.5%），이대장간균거다（6주，18.2%）。약민시험제시혁란양성구균대만고매소、리복평、체고랍저、복방신낙명민감성고，미발현대만고매소내약적금황색포도구균；혁란음성균대아알배남민감성교고(100%)。7례표천감염자경환약후치유；23례심부감염자경상구철저청창，치관충세인류，차균보류내고정，역미견감염복발。결론척주후로술후조기절구감염병원균다위금황색포도구균，대우심부감염자，응조기확창、지속관주충세인류병사용만고매소。
Objective To investigate incision pathogenic bacteria after spinal surgery, and observe clinical effects of therapeutic methods. Methods A total of 30 cases of early surgical incision infection (7 cases of superficial infection and 23 cases of deep infection) after spinal surgery were retrospectively analyzed. The basic data including clinical manifes-tations, diagnosis, treatment, etiology and follow-up results were analyzed. Results It was found that the mean infection time after operation was 2-15 days in 30 patients. Thirty-three strains were isolated including 18 gram-positive cocci (54.5%, and Staphylococcus aureus account for 13, 39.4%), 15 gram-negative bacteria (45.5%, and Coli communior account for 6, 18.2%). The drug susceptibility test showed that gram-positive cocci were highly sensitive to vancomycin, rifampin, tei-coplanin and cotrimoxazole. No vancomycin-resistant Staphylococcus aureus were found. Gram negative bacteria were high-ly sensitive to imipenem (100%). Seven cases of superficial infection were cured after dressing. Twenty-three cases of deep incision wound infection were no recurrence of infection after treatment by deep wound debridement, and postoperative cathe-terization. Conclusion The early wound infection after spinal surgery is usually due to Staphylococcus aureus. It is good to perform wound debridement, continuous perfusion drainage, and treatment with vancomycin for deep wound infection.