下腰椎病变椎弓根螺钉系统内固定术后急性感染的治疗

目的探讨下腰椎病变患者行椎弓根螺钉内固定手术后并发急性感染的治疗方法。方法 1995年1月－2009年12月行椎弓根螺钉内固定术治疗下腰椎病变的患者中22例并发急性感染,回顾性分析感染后的治疗过程。其中男9例,女13例;年龄为37－68岁,平均53.8岁。患者于术后5－21 d出现感染。明确诊断后即行手术者18例（清创后取出内固定器2例,单纯清创16例）,非手术治疗4例。结果取出内固定器的2例患者均Ⅰ期愈合;单纯清创的患者中13例Ⅰ期愈合,3例未好转,再次清创并取出内固定器后伤口愈合。非手术治疗的患者经治疗后1例好转,3例未好转,延期行病灶清除并取出内固定器后伤口愈合。全部患者均获得随访,随访时间为8－60个月,平均27.5个月,无患者出现再感染。患者中18例于4－6个月达到植骨融合。结论下腰椎病变椎弓根螺钉内固定术后一旦出现急性感染,应及时采取手术治疗,是否保留内固定应根据具体情况决定。

Treatment of postoperative acute infection after internal fixation for patients with lower lumbar vertebral diseases by transpedicular screw system

Objective To determine the best therapeutic strategy in the treatment of postoperative acute infection surgical procedures after internal fixation for patients with lower lumbar vertebral diseases by transpedicular screw system. Methods Surgical procedures for 22 patients (9 males and 13 females) with postoperative acute infection were analyzed retrospectively, who underwent internal fixtion by transpedicular screw system to treat lower lumbar vertebral diseases from January 1995 to December 2009. The average age of the patients was 53.8 years (37-68 years). Postoperative acute infections occurred at 5-21 d after internal fixation. After final diagnosis, 18 cases underwent surgical procedures (2 case with debridement and removal of internal fixators, 16 cases with debridement only), while 4 cases underwent non-surgical management.Results In the patients that underwent surgical procedures, 2 cases treated by debridement and removal of implants were healed at the first stage; in the other patients with debridement only, 13 cases were healed at the first stage, and 3 case that didn't got primary healing recovered after another debridement and removal of the implants. In patients with non-surgical management, 1 case recovered and the other 3 cases recovered after debridement and removal of the implants. All patient were followed up with a mean pieriod of 27.5 months (8-60 moths), and no infection occurred again. Fusion were obtained in 18 cases at 4-6 months after operation. Conclusion Once acute infection occur after internal fixation by transpedicular screw system, surgical procedures should be performed in time, and removal of implants can be accepted if necessary.