Treatment strategy for incision infection after internal fixation in the elderly patients with lumbar degenerative disease

doi:10.3969/j.issn.2095-4344.2017.27.010

Abstract

Abstract:

BACKGROUND: With more and more elderly patients suffering lumbar degenerative disease undergoing internal fixation, infection after spinal internal fixation is a common complication in orthopedic surgeries, but its treatment strategy remains controversial.

OBJECTIVE: To explore the curative efficacy of incision infection after internal fixation in the elderly with lumbar degenerative disease.

METHODS: 197 patients with lumbar degenerative disease undergoing internal fixation and followed up for more than 2 years admitted in Department of Orthopedics, Beijing Shijitan Hospital Affiliated to Capital Medical University from January 2012 to January 2015, were analyzed retrospectively. The follow-up time was 2-4.9 years. There were 97 cases of lumbar stenosis, 29 cases of lumbar disc herniation, 33 cases of lumbar spondylolisthesis, 17 cases of degenerative scoliosis and 21 cases of lumbar compression fractures.

RESULTS AND CONCLUSION: (1) Eleven patients experienced incision infection, including ten acute, and one delayed infection. (2) Among acute infected cases, three were superficial infection in three cases and seven had deep infection, who characterized as exudation (10/10), local pain (8/10) and fever (9/10). Acute infected cases received bacterial culture, drug sensitive test, antibiotic therapy, and debridement of the infected wound, and leaving all internal fixators in situ in all but one case. (3) For delayed infection, one patient had local pain, incision exudation, and intermittent fever, and then the internal fixators were removed. (4) Pseudarthrosis was not founded during 2-year follow-up in all patients. (5) These results suggest that for the elderly patients suffering lumbar degenerative disease with infection after internal fixation, intravenous antibiotics, debridement plus drainage are recommended, but without internal fixator removal, and repetitive debridement and drainage is a rational choice if necessary.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Lumbar Vertebrae, Internal Fixators, Infection, Tissue Engineering

CLC Number:

R318

Zhang Hai-jing, Sun Xiang-jie, Ma Hai-gang, Zhou Zhuo, Fang Xiu-tong. Treatment strategy for incision infection after internal fixation in the elderly patients with lumbar degenerative disease[J]. Chinese Journal of Tissue Engineering Research, 2017, 21(27): 4318-4323.

Figures/Tables 3

2.4 术后感染处理切口急性表浅感染患者的处理是局部清创引流或清创后放置负压吸引，同时行细菌培养及药物敏感实验，3例切口急性表浅感染患者均治愈。7例切口急性深部感染患者的治疗行血培养检查，渗出物或者超声引导下感染区域穿刺行病原体培养，静滴光谱抗生素和万古霉素，如果患者体温升高持续不退，同时伴有切口渗出液及流脓，应立即进入手术室行切口彻底清创，保留内固定物，清创坏死组织和植骨材料，将坏死组织及渗出物培养，冲洗枪含有抗生素10 L盐水冲洗感染伤口，放置闭合冲洗管，逐层缝合切口。术后根据培养结果，选择敏感抗生素静滴4-6周，继续口服抗生素2-6周。闭合冲洗管放置三至四周，如果连续2次培养冲洗管引出液体阴性，可以拔出冲洗管。只有1例患者清创2次，持续发热，给予清除内固定物，彻底清除，感染控制，其余9例患者均保留内固定物。 1例迟发性感染患者为迟发性深部感染，给予取出内固定器械，彻底清创，放置闭合冲洗管，冲洗2周，拔除引流管治愈，术中探查无假关节形成。术后切口感染患者中，深部感染的发生率明显高于表浅感染(P < 0.05)，急性感染明显高于迟发性感染(P < 0.05)，见表2。表浅感染的治疗原则无争议。切口急性深部感染与迟发性感染治疗方案并不相同，急性深部感染往往可以保留内固定器械，而迟发性感染往往要取出内固定器械。 11例切口感染患者中，4例为单一细菌感染，其中1例患者为金黄色葡萄球菌感染，3例为耐药金黄色葡萄球菌感染；3例为多种细菌混合感染，分别为大肠埃希菌和鲍曼不动杆菌，铜绿假单胞菌和粪肠球菌，产气肠杆菌和大肠埃希菌；4例感染患者未检测出细菌。 11例感染患者均行渗出物培养，并做药敏实验，根据感染科专家给予指导意见，结合培养结果，表浅感染一般选择敏感抗生素静滴2周，2周后继续口服抗生素2-4周；深部感染根据培养结果，选择敏感抗生素静滴4-6周，4-6周后继续口服抗生素2-6周。 "

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