CAJ | 학술논문

背景：胸腰椎内固定后感染临床上并不罕见，一旦发生后果十分严重。在治疗感染时，是否取出内固定还存在争议。 　　目的：探讨保留内固定治疗胸腰椎术后感染的安全性。 　　方法：2008年3月至2012年12月自贡市第四人民医院骨科共进行胸腰椎内固定手术358例，术后发生早期和晚期感染共13例，男5例，女8例；平均年龄54.5岁(31-65岁)。患者经过积极清创、引流和抗感染治疗，观察治疗后伤口愈合情况，并对比分析清创引流术前、术后6个月的血液分析结果、血沉、C-反应蛋白和目测类比评分结果。 　　结果与结论：13例患者感染发生时间为内固定后1-13个月。经过及时诊断和彻底的病灶清除、冲洗引流、抗感染治疗，除对1例内固定后5个月感染的T12骨折患者取出内固定物外，其余12例患者在保留内固定的情况下治愈感染。随访时间8-40个月，无复发病例。清创引流术前与术后6个月血液分析结果、血沉、C-反应蛋白和腰痛目测类比评分比较，差异有显著性意义(P <0.05)。提示胸腰椎内固定后感染后应及时明确诊断，尽早手术治疗。经过彻底的病灶清除、冲洗引流和抗感染治疗，多数患者可以很快缓解症状，保留内固定的情况下，治愈感染。
배경：흉요추내고정후감염림상상병불한견，일단발생후과십분엄중。재치료감염시，시부취출내고정환존재쟁의。 　　목적：탐토보류내고정치료흉요추술후감염적안전성。 　　방법：2008년3월지2012년12월자공시제사인민의원골과공진행흉요추내고정수술358례，술후발생조기화만기감염공13례，남5례，녀8례；평균년령54.5세(31-65세)。환자경과적겁청창、인류화항감염치료，관찰치료후상구유합정황，병대비분석청창인류술전、술후6개월적혈액분석결과、혈침、C-반응단백화목측류비평분결과。 　　결과여결론：13례환자감염발생시간위내고정후1-13개월。경과급시진단화철저적병조청제、충세인류、항감염치료，제대1례내고정후5개월감염적T12골절환자취출내고정물외，기여12례환자재보류내고정적정황하치유감염。수방시간8-40개월，무복발병례。청창인류술전여술후6개월혈액분석결과、혈침、C-반응단백화요통목측류비평분비교，차이유현저성의의(P <0.05)。제시흉요추내고정후감염후응급시명학진단，진조수술치료。경과철저적병조청제、충세인류화항감염치료，다수환자가이흔쾌완해증상，보류내고정적정황하，치유감염。
BACKGROUND:Surgical site infection of instrumented thoracolumbar spine is not rare and may induce serious consequences. There’s controversy about whether to remove the internal fixation in the treatment of infection. OBJECTIVE: To evaluate the safety of the treatment for surgical site infection of thoracolumbar spine without removing internal fixation. METHODS:A total of 358 patients underwent thoracolumbar internal fixation in Department of Orthopedics, the Fourth People’s Hospital of Zigong City, between March 2008 and December 2012. Among them, 13 cases appeared surgical site infection of instrumented thoracolumbar spine, including 5 males and 8 females. The average age of the 13 cases was 54.5 years (31-65 years). After patients were treated with aggressive debridement, irrigation and anti-infective therapy, the wound healings were evaluated. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score were analyzed and compared before debridement and 6 months after debridement. RESULTS AND CONCLUSION: The 13 patients had surgical site infection of instrumented thoracolumbar spine during 1 to 13 months post-operation. After timely diagnosis, aggressive debridement and irrigation, as wel as sensitive antibiotic therapy, 12 patients succeeded in curing infection and retaining implants. 1 patient with T12 fracture removed the fixation and cured infection. The folow-up time was 8-40 months, no case recurred. The hemanalysis, erythrocyte sedimentation rate, C-reactive protein and visual analogous scale score showed significant difference before debridement and 6 months after debridement (P < 0.05). Postoperative infection after thoracolumbar internal fixation should be timely diagnosis and receive surgical treatment. Through aggressive debridement, irrigation and sensitive antibiotic therapy, most patients can be cured without removing internal fixation.