脊柱椎弓根螺钉系统内固定术后迟发性感染的处理
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摘要
目的研究脊柱椎弓根螺钉系统内固定术后迟发性感染的不同处理方法对患者的影响。方法从本院收治胸腰椎损伤需行脊柱椎弓根螺钉系统内固定术患者278例中选出术后迟发性感染患者60例纳为研究对象,依据处理方法不同,将其分为研究组(n=30,接受常规迟发性感染综合处理+人免疫球蛋白治疗)和对照组(n=30,接受常规迟发性感染综合处理),比较两组患者住院时间、留置管留置时间等一般情况以及治疗前后不同时间红细胞沉降率(ESR)及C-反应蛋白(CRP)。结果研究组患者住院天数(15.26±3.01)d、抗菌药物使用天数(13.20±2.33)d、留置管留置天数(3.09±0.53)d均低于对照组对应的(17.77±3.81)d、(15.65±3.42)d、(4.22±1.02)d,差异具有统计学意义(P<0.05);治疗后3 d、治疗后7 d,两组患者ESR水平均呈显著降低趋势(P<0.05),且研究组治疗后3 d、治疗后7 d的ESR水平均低于对照组对应水平(P<0.05);治疗后3 d、治疗后7 d,两组患者CRP水平均呈显著降低趋势(P<0.05),且研究组治疗后3 d、治疗后7 d的CRP水平均低于对照组对应水平(P<0.05)。结论在常规迟发性感染综合处理基础上给予人免疫球蛋白治疗,更能有效控制感染,提高治疗效果。
Objective To study the effect of different management methods of delayed infection after pedicle screw system fixation on patients.Methods Sixty patients with delayed infection were selected from 278 patients with thoracolumbar spine injury who were treated with pedicle screw system fixation. According to different treatment methods, 60 patients were divided into study group(n=30). The patients in the two groups were treated with human immunoglobulin(hIg) and control group(n=30). The hospitalization time, the retention time and the erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) at different time points before and after treatment were compared between the two groups. Results The days of hospitalization(15.26±3.01)d, antibiotic use(13.20±2.33) d and indwelling tube(3.09±0.53) d in the study group were lower than those in the control group(17.77±3.81) d,(15.65±3.42) d,(4.22±1.02), the difference was statistically significant(P<0.05). The level of ESR in the study group was significantly lower than that in the control group(P<0. 05), and the level of ESR in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0. 05). The level of CRP in the study group was significantly lower than that in the control group at 3 days and 7 days after treatment(P<0. 05), and the level of CRP in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0. 05). Conclusion The treatment of human immunoglobulin on the basis of routine treatment of delayed infection can effectively control infection and improve the therapeutic effect.
Objective To study the effect of different management methods of delayed infection after pedicle screw system fixation on patients.Methods Sixty patients with delayed infection were selected from 278 patients with thoracolumbar spine injury who were treated with pedicle screw system fixation. According to different treatment methods, 60 patients were divided into study group(n=30). The patients in the two groups were treated with human immunoglobulin(hIg) and control group(n=30). The hospitalization time, the retention time and the erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) at different time points before and after treatment were compared between the two groups. Results The days of hospitalization(15.26±3.01)d, antibiotic use(13.20±2.33) d and indwelling tube(3.09±0.53) d in the study group were lower than those in the control group(17.77±3.81) d,(15.65±3.42) d,(4.22±1.02), the difference was statistically significant(P<0.05). The level of ESR in the study group was significantly lower than that in the control group(P<0. 05), and the level of ESR in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0. 05). The level of CRP in the study group was significantly lower than that in the control group at 3 days and 7 days after treatment(P<0. 05), and the level of CRP in the study group was lower than that in the control group 3 days after treatment and 7 days after treatment(P<0. 05). Conclusion The treatment of human immunoglobulin on the basis of routine treatment of delayed infection can effectively control infection and improve the therapeutic effect.
引文
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[11]严峻,郑勇,谢耀杰,等.胸腰椎后路术后切口感染的治疗策略[J].颈腰痛杂志,2016,37(2):115-118.
[12]黄凯.CRP与ESR在骨科内固定手术后的表达变化及意义[J].标记免疫分析与临床,2016,23(8):874-877.
[2]关凯,王飞,林宜韻,等.腰椎后路融合内固定术后近端邻近节段迟发性感染3例报告[J].中国脊柱脊髓杂志,2016,26(10):946-950.
[3]袁海胜,胡泊,吴新萍.脊柱内固定术后感染的临床分析与内置物保留治疗[J].中华医院感染学杂志,2015,25(12):2831-2833.
[4]马晓生,郑超君,姜雷,等.脊柱手术后切口深部感染的早期判断[J].中国脊柱脊髓杂志,2015,25(11):971-976.
[5]江佳佳,傅建国,王淑颖,等.2016年美国《IDSA和SHEA“实施抗生素管理项目”指南》第三部分[J].中华医院感染学杂志,2016,26(21):4557-4560.
[6]张海静,孙湘杰,马海港,等.老年人腰椎退行性疾病植入物内固定后切口感染的治疗策略[J].中国组织工程研究,2017,21(27):4318-4323.
[7]邓华.骨科无菌手术切口感染临床分析及护理对策[J].中华医院感染学杂志,2016,21(20):2689-2690.
[8]张宏亮,黄振光,邹小琴,等.静注人免疫球蛋白临床指南的比较研究[J].中国新药与临床杂志,2016,35(1):58-63.
[9]谢晓曼,张传龙,李洁,等.静注人免疫球蛋白在治疗新生儿感染性肺炎中应用价值[J].临床肺科杂志,2014,19(5):818-820.
[10]郎明磊.脊柱椎弓根螺钉复位内固定术后患者医院感染临床特征及治疗方法[J].中国医药导报,2016,13(6):103-106.
[11]严峻,郑勇,谢耀杰,等.胸腰椎后路术后切口感染的治疗策略[J].颈腰痛杂志,2016,37(2):115-118.
[12]黄凯.CRP与ESR在骨科内固定手术后的表达变化及意义[J].标记免疫分析与临床,2016,23(8):874-877.