有创操作后椎间隙感染的诊疗
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摘要
椎间隙感染是脊柱各种有创操作后严重的并发症,其不仅延长了卧床时间、增加患者的痛苦,也增加了死亡率,产生严重后果。不同学者对椎间隙感染的病因学报道不同,且关于诊断依据与治疗方法尚未达成统一意见。本文就近年来国内外对有创操作后椎间隙感染的危险因素、临床诊断和治疗做一综述。
Intervertebral space infection is a serious complication after various invasive spine operations. It not only extends the bed time and increases the patient's suffering, but also increases the mortality and leads serious consequences. The scholars have different opinions about the pathogenesis of this kind of infection, and no consensus reached on the basis for diagnosis and treatment. This article reviews the risk factors, clinical diagnosis and treatment of intervertebral space infection after invasive operation in recent years.
Intervertebral space infection is a serious complication after various invasive spine operations. It not only extends the bed time and increases the patient's suffering, but also increases the mortality and leads serious consequences. The scholars have different opinions about the pathogenesis of this kind of infection, and no consensus reached on the basis for diagnosis and treatment. This article reviews the risk factors, clinical diagnosis and treatment of intervertebral space infection after invasive operation in recent years.
引文
[1]Turnbull F.Postoperative inflammatory disease of lumbar discs[J].J Neurosurg,1953,10(5):469-473.
[2]Wiese M,Kramer J,Bernsmann K,et al.The related out-come and complication rate in primary lumbar microscopic disc surgery depending on the surgeons'experience:comparative studies[J].Spine,2004,4(5):550.
[3]吴五洲,孙艳玲,王达义,等.腰椎间盘椎间隙感染的诊治分析[J].颈腰痛杂志,2008,29(6):552.
[4]Fouquet B,Goupille P,attiot F,et al.Discits after lumberdisc surgery:features of“aseptic”and“septic”forms[J].Spine,1992,17(5):356.
[5]Quinones-Hinojosa A,Jun P,Jacobs R,et al.General principles in the medical and surgical management of spinal infection:a multidisciplinary approach[J].Neurosurg Focus,2004,17(12):1.
[6]Xing D,Ma JX,Ma XL,et al.A methodological,systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery[J].Eur Spine J,2013,22:605-615.
[7]Fang A,Hu SS,Endres N,et al.Risk factors for infection after spinal surgery[J].Spine(Phila Pa 1976),2005,30:1460-1465.
[8]Pullter Gunne AF,Cohen DB.Incidence,prevalence,and analysis of risk factors for surgical site infection following adult spinal surgery[J].Spine(Phila Pa 1976),2009,34:1422-1428.
[9]Veeravagu A,Patil CG,Lad SP,et al.Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries[J].Spine(Phila Pa 1976),2009,34:1869-1872.
[10]Cizik AM,Lee MJ,Martin BI,et al.Using the spine surgical invasiveness index to identify risk of surgical site infection:a multivariate analysis[J].J Bone Joint Surg Am,2012,94:335-342.
[11]Rasouli MR,Restrepo C,Maltenfort MG,et al.Risk factors for surgical site infection following total joint arthroplasty[J].J Bone Joint Surg Am,2014,96:e158.
[12]Wang T,Wang H,Yang DL,et al.Factorsredicting surgical site infection after posterior lumbar surgery[J].Medicine(Baltimore),2017,96(5):e6042.
[13]Koutsoumbelis S,Hughes AP,Girardi FP,et al.Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis[J].J Bone Joint Surg Am,2011,93(17):1627-1633.
[14]何丁文,姚玉龙,邓中博,等.经皮椎间孔镜技术翻修腰椎融合术后椎间隙感染[J].中国矫形外科杂志,2017,25(11):1042-1044.
[15]Levi ADO,Dickman CA,Sonntag VKH.Management of postoperative infections after spinal instrumentation[J].J Neurosurg,1997,86:975-980.
[16]李开华,于秀淳,刘晓平,等.不明原因性腰椎间隙感染6例诊治分析[J].中国矫形外科杂志,2005,13(7):558.
[17]An HS,Seldomridge JA.Spinal infections:diagnostic testsand imaging studies[J].Clin Orthop,2006,444(1):27.
[18]徐鹏,孙正令,傅翔,等.腰椎术后椎间隙感染早期影像学分析[J].中国辐射卫生,2017,26(2):244-245.
[19]黄俊,谢威,王鹏飞,等.MRI对腰椎间隙感染的早期诊断和治疗价值[J].临床骨科杂志,2005,8(3):221.
[20]浦智韬,金中高,陈松平,等.磁共振成像对腰椎间盘突出症术后椎间隙感染的早期诊断评价[J].中华医院感染学杂志,2017,27(4):853-856.
[21]Ferroni A,AlKhoury H,Dana C,et al.Prospective survey of acuteosteoarticular infections in a French paediatric orthopedic surgery[J].Clin Microbiol Infect,2013,19(9):822-828.
[22]张旭,张春和,高金伟,等.腰椎间盘术后椎间隙感染的早期诊断治[J].中国矫形外科杂志,2005,2:232.
[23]薛红军.腰椎术后椎间隙感染的临床诊治分析[J].吉林医学,2012,(16):3410-3412.
[24]Boscardin JB,Ringus JC,Feingold DJ,et al.Human intradiscal levels with cefazolin[J].Spine(Phila Pa 1976),1992,17:145-148.
[25]Oishi CS,Carrion WV,Hoaglund FT.Use of parenteral prophylactic antibiotics in clean orthopaedic surgery.A review of the literature[J].Clin Orthop,1993,296:249-255.
[26]Riley LH,Banovac K,Martinez OV,et al.Tissue distribution of antibiotics in the intervertebral disc[J].Spine(Phila Pa 1976),1994,19:2619-2625.
[27]谢学斌,杨建勇,余文昌,等.抗生素在椎间盘髓核组织内药物动力学变化的实验研究──静脉和经皮穿刺椎间盘给药的比较[J].临床放射学杂志,2003(12):1-7.
[28]吴柳婷,黄艳芳,罗洁丽.1例多重耐药铜绿假单胞菌椎间隙感染患者的药学监护[J].中国药师,2017,20(4):694-696.
[29]Quinones HA,Jun P,Jacobs R,et al.General principles in the medical and surgical management of spinal infection:a multidisciplinary approach[J].Neurosurg Focus,2004,17(12):1
[30]Nolla JM,Ariza J,Gómez-Vaquero C,et al.Spontaneous pyogenic vertebral osteomyelitis in nondrug users[J].Semin ArthritisRheum,2002,31(4):271-278
[31]Bhagat S,Mathieson C,Jandhyala R,et al.Spondylodiscitis(disc space infection)associated with negative microbiological tests:comparison of outcome of suspected disc space infections to documented non-tuberculous pyogenic discitis[J].Br J Neurosurg,2007,21(5):473.
[32]Silber JS,Anderson DG,Vaccaro AR,et al.Managementofpostprocedural discitis[J].Spine J,2002,2(4):279.
[33]Kutlay M,Colak A,Simsek H,et al.Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis[J].Undersea Hyperb Med,2008,35(6):427.
[34]杨德顺,刘振华,周建生,等.椎间隙感染的治疗(附42例临床分析)[J].中国骨与关节损伤杂志,2010,25(11):1012-1013.
[35]鲁秀国,王娟,王延国,等.一期病灶清除植骨融合内固定治疗原发性腰椎间隙感染[J].中国骨与关节损伤杂志,2015,30(S1):62-63.
[36]袁宏伟.椎间孔镜治疗椎间隙感染[J].中国矫形外科杂志,2017,25(19):1820-1822.
[37]何丁文,姚玉龙,邓中博,等.经皮椎间孔镜技术翻修腰椎融合术后椎间隙感染[J].中国矫形外科杂志,2017,25(11):1042-1044.
[38]戚超,蔡琰,李君,等.经椎间盘镜微创手术治疗腰椎间隙感染[J].中国骨与关节损伤杂志,2010,(5):450-451.
[39]徐勇,李锋,熊伟,等.一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染[J].中国脊柱脊髓杂志,2016,26(9):827-832.
[40]Mok JM,Guillaume TJ,Talu U,et al.Clinical outcome of deep wound infection after instrumented posterior spinal fusion:a matched cohort analysis[J].Spine(Phila Pa 1976),2009,34:578-583.
[41]杨德顺,刘振华,周建生,等.椎间隙感染的治疗[J].中国骨与关节损伤杂志,2010,(11):1012-1013
[42]王锋,龙耀武,赵晓东,等.病灶清除植骨融合治疗腰椎术后迟发性椎间隙感染[J].实用骨科杂志,2013,(5):414-417
[43]程维,宋扬.后路椎间融合固定术后并发椎间感染12例诊疗分析[J].中国矫形外科杂志,2013,(9):933-936.
[44]潘刚明,钟润泉,王非.腰椎间盘术后椎间隙感染的后路手术治疗[J].中国中医骨伤科杂志,2013,(06):42-43+45.
[45]刘连涛,张文武,马树伟,等.原切口病灶清除术在腰椎术后椎间隙感染治疗中的作用[J].中国医药指南,2012,(8):397-398.
[46]孟纯阳,李庆伟,唐可,等.一期病灶清除闭式冲洗治疗腰椎内固定术后感染[J].中国修复重建外科杂志,2010,(9):1088-1091.
[2]Wiese M,Kramer J,Bernsmann K,et al.The related out-come and complication rate in primary lumbar microscopic disc surgery depending on the surgeons'experience:comparative studies[J].Spine,2004,4(5):550.
[3]吴五洲,孙艳玲,王达义,等.腰椎间盘椎间隙感染的诊治分析[J].颈腰痛杂志,2008,29(6):552.
[4]Fouquet B,Goupille P,attiot F,et al.Discits after lumberdisc surgery:features of“aseptic”and“septic”forms[J].Spine,1992,17(5):356.
[5]Quinones-Hinojosa A,Jun P,Jacobs R,et al.General principles in the medical and surgical management of spinal infection:a multidisciplinary approach[J].Neurosurg Focus,2004,17(12):1.
[6]Xing D,Ma JX,Ma XL,et al.A methodological,systematic review of evidence-based independent risk factors for surgical site infections after spinal surgery[J].Eur Spine J,2013,22:605-615.
[7]Fang A,Hu SS,Endres N,et al.Risk factors for infection after spinal surgery[J].Spine(Phila Pa 1976),2005,30:1460-1465.
[8]Pullter Gunne AF,Cohen DB.Incidence,prevalence,and analysis of risk factors for surgical site infection following adult spinal surgery[J].Spine(Phila Pa 1976),2009,34:1422-1428.
[9]Veeravagu A,Patil CG,Lad SP,et al.Risk factors for postoperative spinal wound infections after spinal decompression and fusion surgeries[J].Spine(Phila Pa 1976),2009,34:1869-1872.
[10]Cizik AM,Lee MJ,Martin BI,et al.Using the spine surgical invasiveness index to identify risk of surgical site infection:a multivariate analysis[J].J Bone Joint Surg Am,2012,94:335-342.
[11]Rasouli MR,Restrepo C,Maltenfort MG,et al.Risk factors for surgical site infection following total joint arthroplasty[J].J Bone Joint Surg Am,2014,96:e158.
[12]Wang T,Wang H,Yang DL,et al.Factorsredicting surgical site infection after posterior lumbar surgery[J].Medicine(Baltimore),2017,96(5):e6042.
[13]Koutsoumbelis S,Hughes AP,Girardi FP,et al.Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis[J].J Bone Joint Surg Am,2011,93(17):1627-1633.
[14]何丁文,姚玉龙,邓中博,等.经皮椎间孔镜技术翻修腰椎融合术后椎间隙感染[J].中国矫形外科杂志,2017,25(11):1042-1044.
[15]Levi ADO,Dickman CA,Sonntag VKH.Management of postoperative infections after spinal instrumentation[J].J Neurosurg,1997,86:975-980.
[16]李开华,于秀淳,刘晓平,等.不明原因性腰椎间隙感染6例诊治分析[J].中国矫形外科杂志,2005,13(7):558.
[17]An HS,Seldomridge JA.Spinal infections:diagnostic testsand imaging studies[J].Clin Orthop,2006,444(1):27.
[18]徐鹏,孙正令,傅翔,等.腰椎术后椎间隙感染早期影像学分析[J].中国辐射卫生,2017,26(2):244-245.
[19]黄俊,谢威,王鹏飞,等.MRI对腰椎间隙感染的早期诊断和治疗价值[J].临床骨科杂志,2005,8(3):221.
[20]浦智韬,金中高,陈松平,等.磁共振成像对腰椎间盘突出症术后椎间隙感染的早期诊断评价[J].中华医院感染学杂志,2017,27(4):853-856.
[21]Ferroni A,AlKhoury H,Dana C,et al.Prospective survey of acuteosteoarticular infections in a French paediatric orthopedic surgery[J].Clin Microbiol Infect,2013,19(9):822-828.
[22]张旭,张春和,高金伟,等.腰椎间盘术后椎间隙感染的早期诊断治[J].中国矫形外科杂志,2005,2:232.
[23]薛红军.腰椎术后椎间隙感染的临床诊治分析[J].吉林医学,2012,(16):3410-3412.
[24]Boscardin JB,Ringus JC,Feingold DJ,et al.Human intradiscal levels with cefazolin[J].Spine(Phila Pa 1976),1992,17:145-148.
[25]Oishi CS,Carrion WV,Hoaglund FT.Use of parenteral prophylactic antibiotics in clean orthopaedic surgery.A review of the literature[J].Clin Orthop,1993,296:249-255.
[26]Riley LH,Banovac K,Martinez OV,et al.Tissue distribution of antibiotics in the intervertebral disc[J].Spine(Phila Pa 1976),1994,19:2619-2625.
[27]谢学斌,杨建勇,余文昌,等.抗生素在椎间盘髓核组织内药物动力学变化的实验研究──静脉和经皮穿刺椎间盘给药的比较[J].临床放射学杂志,2003(12):1-7.
[28]吴柳婷,黄艳芳,罗洁丽.1例多重耐药铜绿假单胞菌椎间隙感染患者的药学监护[J].中国药师,2017,20(4):694-696.
[29]Quinones HA,Jun P,Jacobs R,et al.General principles in the medical and surgical management of spinal infection:a multidisciplinary approach[J].Neurosurg Focus,2004,17(12):1
[30]Nolla JM,Ariza J,Gómez-Vaquero C,et al.Spontaneous pyogenic vertebral osteomyelitis in nondrug users[J].Semin ArthritisRheum,2002,31(4):271-278
[31]Bhagat S,Mathieson C,Jandhyala R,et al.Spondylodiscitis(disc space infection)associated with negative microbiological tests:comparison of outcome of suspected disc space infections to documented non-tuberculous pyogenic discitis[J].Br J Neurosurg,2007,21(5):473.
[32]Silber JS,Anderson DG,Vaccaro AR,et al.Managementofpostprocedural discitis[J].Spine J,2002,2(4):279.
[33]Kutlay M,Colak A,Simsek H,et al.Antibiotic and hyperbaric oxygen therapy in the management of post-operative discitis[J].Undersea Hyperb Med,2008,35(6):427.
[34]杨德顺,刘振华,周建生,等.椎间隙感染的治疗(附42例临床分析)[J].中国骨与关节损伤杂志,2010,25(11):1012-1013.
[35]鲁秀国,王娟,王延国,等.一期病灶清除植骨融合内固定治疗原发性腰椎间隙感染[J].中国骨与关节损伤杂志,2015,30(S1):62-63.
[36]袁宏伟.椎间孔镜治疗椎间隙感染[J].中国矫形外科杂志,2017,25(19):1820-1822.
[37]何丁文,姚玉龙,邓中博,等.经皮椎间孔镜技术翻修腰椎融合术后椎间隙感染[J].中国矫形外科杂志,2017,25(11):1042-1044.
[38]戚超,蔡琰,李君,等.经椎间盘镜微创手术治疗腰椎间隙感染[J].中国骨与关节损伤杂志,2010,(5):450-451.
[39]徐勇,李锋,熊伟,等.一期前路病灶清除植骨融合联合后路经Wiltse入路椎弓根螺钉内固定治疗L5/S1椎间隙感染[J].中国脊柱脊髓杂志,2016,26(9):827-832.
[40]Mok JM,Guillaume TJ,Talu U,et al.Clinical outcome of deep wound infection after instrumented posterior spinal fusion:a matched cohort analysis[J].Spine(Phila Pa 1976),2009,34:578-583.
[41]杨德顺,刘振华,周建生,等.椎间隙感染的治疗[J].中国骨与关节损伤杂志,2010,(11):1012-1013
[42]王锋,龙耀武,赵晓东,等.病灶清除植骨融合治疗腰椎术后迟发性椎间隙感染[J].实用骨科杂志,2013,(5):414-417
[43]程维,宋扬.后路椎间融合固定术后并发椎间感染12例诊疗分析[J].中国矫形外科杂志,2013,(9):933-936.
[44]潘刚明,钟润泉,王非.腰椎间盘术后椎间隙感染的后路手术治疗[J].中国中医骨伤科杂志,2013,(06):42-43+45.
[45]刘连涛,张文武,马树伟,等.原切口病灶清除术在腰椎术后椎间隙感染治疗中的作用[J].中国医药指南,2012,(8):397-398.
[46]孟纯阳,李庆伟,唐可,等.一期病灶清除闭式冲洗治疗腰椎内固定术后感染[J].中国修复重建外科杂志,2010,(9):1088-1091.