[1]李骁腾,郭营,李宝田,等.病灶清除联合敏感抗生素治疗腰椎术后早期手术部位感染并发脓毒症[J].中医正骨,2023,35(08):70-75.
点击复制

病灶清除联合敏感抗生素治疗腰椎术后早期手术部位感染并发脓毒症()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期数:
2023年08期
页码:
70-75
栏目:
临床报道
出版日期:
2023-08-20

文章信息/Info

作者:
李骁腾1; 郭营1; 李宝田1; 吕丰姿2; 郭小伟1; 潘玉林1
1.郑州市骨科医院,河南 郑州 450052; 2.河南省人民医院,河南 郑州 450003
关键词:
腰椎;  脓毒症;  手术后并发症;  清创术;  抗生素
摘要:
目的:观察病灶清除联合敏感抗生素治疗腰椎术后早期手术部位感染并发脓毒症的临床疗效及安全性。方法:2015年1月至2021年12月,采用病灶清除联合敏感抗生素治疗腰椎术后早期手术部位感染并发脓毒症患者13例,男9例、女4例。年龄 31～58岁,中位数48岁。所有患者均接受过后路腰椎椎管减压椎间融合器植骨融合术,其中腰椎间盘突出症合并腰椎管狭窄症7例、单纯腰椎滑脱症6例。原手术节段为单节段4例,其中L4～53例,L5S11例; 2节段6例,其中L3～4、L4～54例,L4～5、L5S12例; 3节段3例,其中L2～3、L3～4、L4～52例,L3～4、L4～5、L5S11例。感染累及肌层8例,累及椎体、椎间隙5例。感染并发脓毒症时间,原手术后1～7 d 3例、8～10 d 5例、11～14 d 5例。13例患者中有10例切口愈合不良,且局部有渗出物。体温38.9～40.3 ℃,中位数39.5 ℃。血培养和穿刺液培养结果显示,表皮葡萄球菌3例、金黄色葡萄球菌5例、肺炎克雷伯菌1例、大肠杆菌1例、阴沟肠杆菌3例。记录病灶清除术前后白细胞、C-反应蛋白、红细胞沉降率、降钙素原的检测值,采用Oswestry功能障碍指数(oswestry disability index,ODI)评价腰椎功能,采用疼痛视觉模拟量表(visual analogue scale,VAS)评价腰部、腿部疼痛情况,采用改良MacNab标准评价综合疗效。随访观察并发症发生和内固定物固定等情况。结果:本组13例患者均采用1次清创手术,均于炎症控制后1周出院。所有患者均获随访,随访时间6～24个月,中位数14个月。病灶清除术前、术后3 d、术后7 d、术后14 d的白细胞计数分别为(15.47±7.78)109个·L-1、(12.87±0.14)109个·L-1、(10.28±2.44)109个·L-1、(7.65±0.03)109个·L-1,C-反应蛋白检测值分别为(105.94±22.57)mg·L-1、(90.50±17.39)mg·L-1、(59.99±5.94)mg·L-1、(27.31±2.30)mg·L-1,红细胞沉降率检测值分别为(63±20)mm·h-1、(62±16)mm·h-1、(52±14)mm·h-1、(41±11)mm·h-1,降钙素原检测值分别为(1.64±1.25)ng·mL-1、(1.26±0.84)ng·mL-1、(0.80±0.52)ng·mL-1、(0.55±0.57)ng·mL-1。病灶清除术前、术后3个月、术后6个月和末次随访时的腰部疼痛VAS评分分别为(6.15±1.34)分、(0.54±0.78)分、(0.15±0.38)分和(0.15±0.38)分,腿部疼痛VAS评分分别为(3.08±0.63)分、(0.31±0.63)分、(0.23±0.44)分和(0.08±0.28)分,ODI指数分别为(72.31±10.09)%、(23.54±5.78)%、(16.92±3.23)%和(13.53±3.28)%。末次随访时评价综合疗效,优11例、良2例。至末次随访时,所有患者均未出现感染复发、内固定物松动等并发症。结论:病灶清除联合敏感抗生素治疗腰椎术后早期手术部位感染并发脓毒症,可以有效控制感染、减轻腰腿部疼痛、恢复腰椎功能,且安全性较高,同时无需取出内固定物。

参考文献/References:

[1] ZHOU J,WANG R,HUO X,et al.incidence of surgical site infection after spine surgery:a systematic review and meta-analysis[J].Spine(Phila Pa 1976),2020,45(3):208-216.
[2] 钟可琪,冯岚,马玥,等.脊柱外科手术后切口感染风险预测评估体系的构建[J].中华创伤骨科杂志,2022,24(2):161-167.
[3] DE LA GARZA-RAMOS R,ABT N B,KEREZOUDIS P,et al.Deep-wound and organ-space infection after surgery for degenerative spine disease:an analysis from 2006 to 2012[J].Neurol Res,2016,38(2):117-123.
[4] FAIRBANK J C,PYNSENT P B.The oswestry disability index[J].Spine(Phila Pa 1976),2000,25(22):2940-2952.
[5] 蒋协远,王大伟.骨科临床疗效评价标准[M].北京:人民卫生出版社,2005:123-124.
[6] HANLEY E N Jr,DAVID S M.Lumbar arthrodesis for the treatment of back pain[J].J Bone Joint Surg Am,1999,81(5):716-730.
[7] SEBAALY A,SHEDID D,BOUBEZ G,et al.Surgical site infection in spinal metastasis:incidence and risk factors[J].Spine J,2018,18(8):1382-1387.
[8] 王如来,熊敏,周升.腰椎后路融合术后急性手术部位感染的危险因素分析[J].骨科,2020,11(1):13-18.
[9] 苏新磊,李爱霞,张桂莲,等.脊柱内固定术后早期切口深部感染的诊治探讨[J].生物骨科材料与临床研究,2019,16(3):39-43.
[10] ZHANG F,LIU X,TAN Z,et al.Effect of postoperative hypoalbuminemia and supplement of human serum albumin on the development of surgical site infection following spinal fusion surgery:a retrospective study[J].Eur Spine J,2020,29(7):1483-1489.
[11] PAPPOU I P,PAPADOPOULOS E C,SAMA A A,et al.Postoperative infections in interbody fusion for degenerative spinal disease[J].Clin Orthop Relat Res,2006,444:120-128.
[12] KASLIWAL M K,TAN L A,TRAYNELIS V C.Infection with spinal instrumentation:review of pathogenesis,diagnosis,prevention,and management[J].Surg Neurol Int,2013,4(Suppl 5):S392-S403.
[13] DIVI S N,KEPLER C K,SEGAR A H,et al.Role of imaging,tissue sampling,and biomarkers for diagnosis of SSI in spine surgery[J].Clin Spine Surg,2020,33(5):E199-E205.
[14] SATO K,YAMADA K,YOKOSUKA K,et al.Pyogenic spondylitis:clinical features,diagnosis and treatment[J].Kurume Med J,2019,65(3):83-89.
[15] INOSE H,KOBAYASHI Y,YUASA M,et al.Procalcitonin and neutrophil lymphocyte ratio after spinal instrumentation surgery[J].Spine(Phila Pa 1976),2019,44(23):E1356-E1361.
[16] FUJITA R,TAKAHATA M,KOKABU T,et al.Retrospective study to evaluate the clinical significance of a second rise in C-reactive protein level following instrumented spinal fusion surgery[J].J Orthop Sci,2019,24(6):963-968.
[17] JEAN M,IRISSON J O,GRAS G,et al.Diagnostic delay of pyogenic vertebral osteomyelitis and its associated factors[J].Scand J Rheumatol,2017,46(1):64-68.
[18] ALJABI Y,MANCA A,RYAN J,et al.Value of procalcitonin as a marker of surgical site infection following spinal surgery[J].Surgeon,2019,17(2):97-101.
[19] LI Y D,CHI J E,CHIU P Y,et al.The comparison between anterior and posterior approaches for removal of infected lumbar interbody cages and a proposal regarding the use of endoscope-assisted technique[J].J Orthop Surg Res,2021,16(1):386.
[20] 张宁,曾献军,何来昌,等.脊柱感染的MRI表现及鉴别诊断研究现状[J].磁共振成像,2019,10(3):223-227.
[21] DOWDELL J,BROCHIN R,KIM J,et al.Postoperative spine infection:diagnosis and management[J].Global Spine J,2018,8(4 Suppl):37S-43S.
[22] ABDUL-JABBAR A,BERVEN S H,HU S S,et al.Surgical site infections in spine surgery:identification of microbiolo-gic and surgical characteristics in 239 cases[J].Spine(Phila Pa 1976),2013,38(22):E1425-1431.
[23] BILLIÈRES J,UÇKAY I,FAUNDEZ A,et al.Variables associated with remission in spinal surgical site infections[J].J Spine Surg,2016,2(2):128-134.
[24] SID AHMED M A,BANSAL D,ACHARYA A,et al.Antimicrobial susceptibility and molecular epidemiology of extended-spectrum beta-lactamase-producing Enterobacteriaceae from intensive care units at Hamad Medical Corporation,Qatar[J].Antimicrob Resist Infect Control,2016,5:4.
[25] 刘少强,齐强,陈仲强,等.脊柱术后手术部位感染67例临床分析[J].中华外科杂志,2016,54(7):523-527.
[26] CORNETT C A,VINCENT S A,CROW J,et al.Bacterial spine infections in adults:evaluation and management[J].J Am Acad Orthop Surg,2016,24(1):11-18.
[27] BERBARI E F,KANJ S S,KOWALSKI T J,et al.2015 infectious diseases society of America(IDSA)clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults[J].Clin Infect Dis,2015,61(6):e26-46.
[28] MIYAZAKI S,KAKUTANI K,MAENO K,et al.Surgical debridement with retention of spinal instrumentation and long-term antimicrobial therapy for multidrug-resistant surgical site infections after spinal surgery:a case series[J].Int Orthop,2016,40(6):1171-1177.
[29] PULL TER GUNNE A F,MOHAMED A S,SKOLASKY R L,et al.The presentation,incidence,etiology,and treatment of surgical site infections after spinal surgery[J].Spine(Phila Pa 1976),2010,35(13):1323-1328.
[30] QIN C H,ZHANG H A,CHEE Y H,et al.Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation suction in the treatment of lower lower limb chronic osteomyelitis[J].Injury,2019,50(2):508-514.
[31] 王攀,李涛,王微慎,等.对冲引流术治疗腰椎后路融合术后深部感染的临床疗效[J].颈腰痛杂志,2022,43(3):450-451.
[32] KOBAYASHI K,IMAGAMA S,ANDO K,et al.Trends in reoperation for surgical site infection after spinal surgery with instrumentation in a multicenter study[J].Spine(Phila Pa 1976),2020,45(20):1459-1466.
[33] SCHÖMIG F,PUTZIER M.Clinical presentation and diagnosis of delayed postoperative spinal implant infection[J].J Spine Surg,2020,6(4):772-776.
[34] 崔孔蛟,张玉发.彻底清创保留钉棒系统治疗腰椎内固定术后早期感染的临床观察[J].中国骨与关节损伤杂志,2021,36(3):262-264.
[35] KALFAS F,SEVERI P,SCUDIERI C.Infection with spinal instrumentation:a 20-year,single-institution experience with review of pathogenesis,diagnosis,prevention,and management[J].Asian J Neurosurg,2019,14(4):1181-1189.
[36] 刘少强,齐强,陈仲强,等.影响脊柱术后感染内固定移除的因素分析[J].中国矫形外科杂志,2014,22(6):552-554.
[37] 王岩,刘畅,陈伯华.脊柱术后切口深部感染治疗的研究进展[J].中国脊柱脊髓杂志,2020,30(10):937-941.

相似文献/References:

[1]刘彦璐,林耐球,李绍旦,等.正骨手法结合中药外敷治疗腰椎间盘突出症[J].中医正骨,2015,27(02):26.
[2]邵礼晖,潘浩.Coflex棘突间动态稳定系统治疗腰椎退变性疾病40例[J].中医正骨,2015,27(02):37.
[3]郭新军,朱卉敏,王衡,等.一次性纤维环缝合器在腰椎间盘突出症髓核摘除术中的应用[J].中医正骨,2015,27(03):59.
[4]林斌,黎秋生,何勇,等.椎弓根螺钉单侧固定与双侧固定治疗腰椎间盘突出症 对邻近节段退变的影响[J].中医正骨,2015,27(01):16.
　LIN Bin,LI Qiusheng,HE Yong,et al.Effect of unilateral versus bilateral fixation with pedicle screws on adjacent segment degeneration in patients with lumbar disc herniation[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(08):16.
[5]王世龙.腰椎椎管内外痛风石1例[J].中医正骨,2012,24(02):69.
[6]秦杰,李振宇.三法十式手法配合中药腰痹汤治疗腰椎间盘突出症[J].中医正骨,2011,23(02):71.
[7]颜 峰.椎间融合术配合中药外敷治疗退行性腰椎滑脱症[J].中医正骨,2016,28(01):38.
[8]贾龙,张华.“治未病”思想指导下腰椎间盘突出症的辨证防治[J].中医正骨,2017,29(01):36.
[9]姜文涛,梅伟,王庆德,等.腰椎融合术后邻近节段退变的影响因素分析[J].中医正骨,2017,29(03):3.
　JIANG Wentao,MEI Wei,WANG Qingde,et al.Analysis of factors influencing adjacent segment degeneration after lumbar spinal fusion[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2017,29(08):3.
[10]聂富祥,贺海怿,朱文辉,等.一次性可扩张通道下微创经椎间孔入路腰椎间融合术治疗单节段腰椎退行性疾病[J].中医正骨,2017,29(05):34.

更新日期/Last Update: 1900-01-01