脊柱手术_____脊柱手术；_内固定；

脊柱后路椎弓根螺钉系统内固定术后感染临床分析

http://www.100md.com 《中国矫形外科杂志》 2005年第21期

脊柱手术,,脊柱手术；,内固定；,感染,1对象与方法,2结果,3讨论,参考文献：

     摘要：[目的]探讨脊柱后路椎弓根螺钉内固定系统术后感染的危险因素、诊断及处理方法。[方法]对脊柱后路椎弓根螺钉系统内固定术后并发感染的16例患者的手术时间、术中失血量、围手术期抗生素的使用、临床表现、实验室检查、细菌培养等进行回顾性分析。[结果]本组541例患者，术后感染发生率为298%，手术时间60 min以内、60～120 min、大于120 min术后感染发生率依次为000%，304%，590%；术中失血量<400 ml，400～800 ml，>800 ml术后感染发生率分别为212%，315%，1116%；术后使用抗生素，术中术后使用抗生素，术前术中术后均使用抗生素，术后感染发生率分别为110%，432%，1025%。15例取出内固定者及1例未取出者，切口均甲级愈合。16例患者二次手术后随访11～23个月，均无复发征象。[结论]脊柱后路椎弓根螺钉系统内固定术后感染与手术时间、术中失血量有关，手术失血量越多，手术时间越长，术后越易发生感染，围手术期使用抗生素可有效减少感染的发生；确诊后病灶清除，内固定物取出，灌洗引流，静脉应用有效抗生素，可获得满意疗效。

    关键词：脊柱手术；内固定；感染

    Clinical analysis of postoperative infection after internal fixation of spine

    LI Hongwei,MA Yuanzheng,BAO Da,et al

    Orthopedic Department,the 309th Hospital of PLA,Beijing 100091

    Abstract：[Objective]To study the risk factor,diagnosis and treatment of postoperative infection after internal fixation of spine[Method]A total of 541 cases of internal fixation of spine were reviewed and 16 cases of postoperative infection were studiedOperation time,blood lost,antibiotics administration,clinical symptoms,1aboratory tests and culture reports were studiedThe internal fixations in all 16 patients were removed and the patients underwent debridement and lavageThe specimen obtained in the operation was sent to bacteria cultureOne case of acute infection underwent debridement and lavage after postoperative administration of antibiotics[Result]The postoperative infection rate of 541 patients was 298%The infection rates related to different operation time of less than 60 min,more than 60 min to 120 min,more than 120 min were 000%,304%,590 respectively;the infection rates related to different blood lost of 100 to 400ml,400 to 800ml,more than 800 ml were 212%,315%,1116% respectively;the infection rates related to different antibiotic administration in operation,both in operation and postoperation,and in preoperation,operation and postoperation were 110%,432%, 1025% respectively All patients experienced wound healingAll these 16 patients were followed up for 11~23 months and no complication reoccurred[Conclusion]The occurrence of postoperative infection after internal spinal fixation was related to operationtime,blood lostAntibiotics may be an effective method for prevention of infectionThe surgical procedures should include debridement,internal fixation removal,lavage and antibiotics administration ......

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