灌洗引流法治疗腰椎后路内固定术后切口早期深部感染的疗效分析
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摘要
目的:探讨分析灌洗引流法治疗腰椎后路内固定术后切口早期深部感染的疗效。方法:选取本院2014年6月-2016年12月收治的腰椎后路内固定术后切口早期深部感染患者42例作为研究对象,按照随机数字表法将其分为对照组和研究组,各21例。对照组给予抗生素治疗,研究组给予灌洗引流法治疗,对比分析两组的临床治疗效果、治疗前后的VAS评分及症状复发情况。结果:研究组治疗总有效率为95.24%,明显高于对照组的71.43%,差异有统计学意义(字2=4.286,P=0.038)。治疗后,两组患者的VAS评分均有明显改善,且研究组VAS评分为(4.48±1.50)分,明显低于对照组的(5.48±1.29)分,差异均有统计学意义(P<0.05)。随访12个月后,研究组患者有2例出现症状复发情况,症状复发率为9.52%;对照组有10例出现症状复发情况,症状复发率为47.62%,两组症状复发率对比,差异有统计学意义(字2=7.467,P=0.006)。结论:给予腰椎后路内固定术后切口早期深部感染需要尽快进行手术清创治疗干预以及灌洗引流法等,这样能够获得显著的治疗效果,并且保留内固定,为了确保手术的成功性,在手术期间需要发展多次切除软组织,还需要在椎间隙深层留置导管,这样能够全面降低患者疼痛感,避免术后并发症,值得在临床上推广使用。
Objective:To study and analyze the effect of irrigation and drainage method in the treatment of early deep infection of incision after lumbar posterior internal fixation.Method:A total of 42 patients with early deep infection of incision after lumbar posterior internal fixation from June 2014 to December 2016 in our hospital were selected as the study objects.According to the random number table method,they were divided into control group and research group.The control group was given antibiotics treatment,the research group was given irrigation and drainage method treatment.The clinical therapeutic effect,VAS scores before and after tratment,quality of life scores and symptoms recurrence after follow up 12 months between the two groups were compared and analyzed.Result:The total effective rate of the study group was 95.24%, which was significantly higher than 71.43% of the control group,the difference was statistically significant( 字2=4.286,P=0.038).After treatment,the VAS scores of the two groups were significantly improved, and the VAS score of the study group was(4.48±1.50) score,which was significantly lower than(5.48±1.29) score of the control group,the difference was statistically significant(P<0.05).After follow-up 12 months,two cases in the study group had recurrence of symptoms,the recurrence rate of symptoms was 9.52%;10 cases in the control group,the recurrence rate of symptoms was 47.62%.The recurrence rate of symptoms was compared between the two groups,the difference was statistically significant( 字2=7.467,P=0.006).Conclusion:Early deep infection of incision after lumbar posterior internal fixation needs surgical debridement therapy intervention as soon as possible and irrigation and drainage method,which can gain significant treatment effect and keep internal fixation.In order to ensure the success of the operation,it needs to develop multiple resection of soft tissue during surgery,also needs deep indwelling catheter in intervertebral space,which can reduce the patients' pain and avoid the postoperative complications,so it is worth popularizing in clinic.
Objective:To study and analyze the effect of irrigation and drainage method in the treatment of early deep infection of incision after lumbar posterior internal fixation.Method:A total of 42 patients with early deep infection of incision after lumbar posterior internal fixation from June 2014 to December 2016 in our hospital were selected as the study objects.According to the random number table method,they were divided into control group and research group.The control group was given antibiotics treatment,the research group was given irrigation and drainage method treatment.The clinical therapeutic effect,VAS scores before and after tratment,quality of life scores and symptoms recurrence after follow up 12 months between the two groups were compared and analyzed.Result:The total effective rate of the study group was 95.24%, which was significantly higher than 71.43% of the control group,the difference was statistically significant( 字2=4.286,P=0.038).After treatment,the VAS scores of the two groups were significantly improved, and the VAS score of the study group was(4.48±1.50) score,which was significantly lower than(5.48±1.29) score of the control group,the difference was statistically significant(P<0.05).After follow-up 12 months,two cases in the study group had recurrence of symptoms,the recurrence rate of symptoms was 9.52%;10 cases in the control group,the recurrence rate of symptoms was 47.62%.The recurrence rate of symptoms was compared between the two groups,the difference was statistically significant( 字2=7.467,P=0.006).Conclusion:Early deep infection of incision after lumbar posterior internal fixation needs surgical debridement therapy intervention as soon as possible and irrigation and drainage method,which can gain significant treatment effect and keep internal fixation.In order to ensure the success of the operation,it needs to develop multiple resection of soft tissue during surgery,also needs deep indwelling catheter in intervertebral space,which can reduce the patients' pain and avoid the postoperative complications,so it is worth popularizing in clinic.
引文
[1]段琨,巩守.保留内固定治疗腰椎后路内固定术后早期深部感染的临床疗效观察[J].临床医学研究与实践,2017,2(17):67-68.
[2]Horan T C,Andrus M,Dudeck M A.CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J].Am J Infect Control,2008,36(5):309-332.
[3]朱达惠.20例双侧闭式冲洗引流治疗腰椎内固定术后感染的护理[J].全科护理,2015,13(22):2169-2171.
[4]刘景锋,冯永洪,王新强,等.中西医结合闭式灌洗引流治疗腰椎内固定术后早期感染[J].海峡药学,2015,27(7):91-93.
[5]张军军,郭昭庆,卢占斌,等.清创加碘伏冲洗对降低胸腰椎后路手术感染率的前瞻性研究[J].中国骨与关节损伤杂志,2015,30(3):247-249.
[6]孙海涛,关家文,马宗雷,等.CT引导经皮脊柱内窥镜病灶清除加置管治疗胸腰椎脊柱感染[J].中国骨与关节损伤杂志,2015,30(3):266-268.
[7]骆宏伟,李宏斌,曾青东.胸腰椎骨折患者内固定术后切口深部急性感染的处理[J].中华医院感染学杂志,2015,25(1):196-198.
[8]黄帅豪,柯雨洪,王义生,等.腰椎后路内固定术后感染的原因分析与治疗体会[J].中国矫形外科杂志,2014,22(21):2002-2005.
[9]胡美丽.闭式灌洗引流治疗胸腰椎内固定术后切口感染的护理[J].现代诊断与治疗,2014,25(13):3106-3107.
[10]付能高,张映波,张志明,等.VSD结合灌洗引流治疗胸腰椎术后切口感染[J].实用骨科杂志,2014,20(2):145-148.
[11]黄波.常规保守及早期腹腔镜下置管腹腔灌洗引流法治疗高龄患者消化道穿孔的疗效研究[J].临床合理用药杂志,2014,7(21):14-15.
[12]王会含,王永堂,卢良杰,等.CRP、PCT、ESR及WBC监测在腰椎后路内固定术后早期感染的临床价值分析[J].中华医院感染学杂志,2016,26(22):5175-5178.
[13]罗巧.胸腰椎骨折后路内固定术的手术护理配合分析[J].世界最新医学信息文摘,2016,16(70):293,295.
[14]高东红,利结芳.烟卷式加压包扎法在腰椎后路内固定术后切口护理中的应用效果观察[J].齐鲁护理杂志,2016,22(4):80-81.
[15]王簕,杨波,尹飚,等.在腰椎后路内固定术后早期发热患者中监测4种血清感染指标水平的临床意义[J].中国骨伤,2015,28(1):66-70.
[16]王永刚,康学文,王东敏,等.胸腰椎手术后切口早期深部感染的处理[J].临床骨科杂志,2017,20(3):307-309.
[17]汤世伟.胸腰椎骨折后路内固定术的手术配合[J].当代临床医刊,2017,30(5):3439,3438.
[18]秦梅.对行后路内固定术的胸腰椎骨折患者实施手术配合护理的效果分析[J].当代医药论丛,2015,13(17):130-131.
[19]蒋文英,杨丹.后路内固定术治疗胸腰椎骨折患者的临床手术护理配合干预方法分析[J/OL].实用临床护理学电子杂志,2017,2(3):86,88.
[2]Horan T C,Andrus M,Dudeck M A.CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting[J].Am J Infect Control,2008,36(5):309-332.
[3]朱达惠.20例双侧闭式冲洗引流治疗腰椎内固定术后感染的护理[J].全科护理,2015,13(22):2169-2171.
[4]刘景锋,冯永洪,王新强,等.中西医结合闭式灌洗引流治疗腰椎内固定术后早期感染[J].海峡药学,2015,27(7):91-93.
[5]张军军,郭昭庆,卢占斌,等.清创加碘伏冲洗对降低胸腰椎后路手术感染率的前瞻性研究[J].中国骨与关节损伤杂志,2015,30(3):247-249.
[6]孙海涛,关家文,马宗雷,等.CT引导经皮脊柱内窥镜病灶清除加置管治疗胸腰椎脊柱感染[J].中国骨与关节损伤杂志,2015,30(3):266-268.
[7]骆宏伟,李宏斌,曾青东.胸腰椎骨折患者内固定术后切口深部急性感染的处理[J].中华医院感染学杂志,2015,25(1):196-198.
[8]黄帅豪,柯雨洪,王义生,等.腰椎后路内固定术后感染的原因分析与治疗体会[J].中国矫形外科杂志,2014,22(21):2002-2005.
[9]胡美丽.闭式灌洗引流治疗胸腰椎内固定术后切口感染的护理[J].现代诊断与治疗,2014,25(13):3106-3107.
[10]付能高,张映波,张志明,等.VSD结合灌洗引流治疗胸腰椎术后切口感染[J].实用骨科杂志,2014,20(2):145-148.
[11]黄波.常规保守及早期腹腔镜下置管腹腔灌洗引流法治疗高龄患者消化道穿孔的疗效研究[J].临床合理用药杂志,2014,7(21):14-15.
[12]王会含,王永堂,卢良杰,等.CRP、PCT、ESR及WBC监测在腰椎后路内固定术后早期感染的临床价值分析[J].中华医院感染学杂志,2016,26(22):5175-5178.
[13]罗巧.胸腰椎骨折后路内固定术的手术护理配合分析[J].世界最新医学信息文摘,2016,16(70):293,295.
[14]高东红,利结芳.烟卷式加压包扎法在腰椎后路内固定术后切口护理中的应用效果观察[J].齐鲁护理杂志,2016,22(4):80-81.
[15]王簕,杨波,尹飚,等.在腰椎后路内固定术后早期发热患者中监测4种血清感染指标水平的临床意义[J].中国骨伤,2015,28(1):66-70.
[16]王永刚,康学文,王东敏,等.胸腰椎手术后切口早期深部感染的处理[J].临床骨科杂志,2017,20(3):307-309.
[17]汤世伟.胸腰椎骨折后路内固定术的手术配合[J].当代临床医刊,2017,30(5):3439,3438.
[18]秦梅.对行后路内固定术的胸腰椎骨折患者实施手术配合护理的效果分析[J].当代医药论丛,2015,13(17):130-131.
[19]蒋文英,杨丹.后路内固定术治疗胸腰椎骨折患者的临床手术护理配合干预方法分析[J/OL].实用临床护理学电子杂志,2017,2(3):86,88.