摘要
目的探讨脊柱术后手术部位感染（SSI）的治疗方法。方法回顾性分析2004年7月至2012年12月北京大学第三医院骨科收治的细菌培养结果阳性的67例脊柱术后手术部位感染患者的临床资料、治疗方法、疗效和随访情况。67例患者中，男性39例，女性28例；年龄20～77岁，平均年龄51岁；感染部位位于腰椎47例，位于胸椎5例，位于下颈椎7例，位于上颈椎8例；早期感染64例，迟发性感染3例；浅表切口感染23例，深部切口感染44例；单一细菌感染47例，多重细菌感染20例。在96株病原菌中，62．5％为革兰阳性菌；革兰阳性菌前三位分别是金黄色葡萄球菌、表皮葡萄球菌及粪肠球菌；革兰阴性菌前三位分别是大肠埃希菌、阴沟肠杆菌及鲍曼不动杆菌。所有67例SSI患者均使用抗生素抗感染治疗，其中60例联合彻底清创冲洗、对口置管冲洗引流处理，清创次数1～5次，平均清创次数1．5次。结果67例患者中，1例在住院治疗期间死亡，该患者发生感染时病情危重，表现为高热、言语不清伴背部切口肿胀，血培养证实为MRSA菌血症，住院治疗期间先后发生多重细菌的肺部感染和泌尿系感染，最终因多器官功能衰竭死亡。余66例患者感染症状逐渐缓解并在出院前完全治愈，出院后经25～117个月，平均70个月随访，至末次随访未见感染复发；65例植入内固定患者中，56例内固定得以保留，9例移除内固定后感染得到控制。结论合理应用抗生素、伤口对口置管冲洗引流是处理脊柱术后SSI的有效方法，并应尽可能地保留内固定。
Objective To investigate the treatment of surgical site infection （SSI） after spine surgery. Methods Sixty-seven patients （aged 20 -77 years with mean age of 51 years） with etiologically- confirmed surgical site infection after spine surgery in Peking University Third Hospital between July 2004 and December 2012 were retrospectively analyzed. There were 39 male and 28 female patients; 47 lumbar infections, 4 thoracic infections, 7 lower cervical infections and 8 upper cervical infections; 64 early infections and 3 delayed infections; 23 superficial infections and 44 deep infections; 47 monomicrobial infections and 20 polymicrobial infections. Ninety-six strains of bacteria were identified from the bacterial culture of 67 patients. Sixty strains were gram-positive pathogenic bacteria （62. 5% ）, and the top three species were Staphylococcus aureus, S. epidermidis and Enterococcus faecalis. The remaining 36 strains were gram-negative pathogenic bacteria （37.5%）, and the 3 species most predominant were Escherichia coli, Enterobacter cloacae, and Acinetobacter baumannii. All the patients with SSI were administered antibiotics. Debridement and irrigation-suction was performed if little symptomatic improvement was achieved in two-to-three days of antibiotics treatment, patients underwent 1 -5 times of debridements （mean 1.5 times）. Results One patient was dead of MRSA septicemia, whom manifested as high fever, alalia and incision swelling when the infection occurred. The patient underwent polymicrobial of pulmonary infection and urinary tract infection during the period of hospitalization, and finally died of multiple organ failure. Sixty-six cases had wound healed, and they were followed up for 25 - 117 months （average 70 months）, no recurrence of infection was found at last follow-up. Among the 65 cases of internal fixation, 56 cases reserved the implants, while implants were removed in other 9 cases for controlling infection. Conclusion Reasonable antibiotics and irrigation-suction are effecti
出处
《中华外科杂志》
CAS
CSCD
北大核心
2016年第7期523-527,共5页
Chinese Journal of Surgery
基金
首都临床特色应用研究专项基金（Z141107002514025）
首都卫生发展科研专项基金（2014-3-4096）
关键词
脊柱
外科手术
外科伤口感染
诊断
治疗结果
Spine
Surgical procedures, operative
Surgical wound infection
Diagnosis
Treatment outcome
