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[1]李驍騰,郭營,李寶田,等.病灶清除聯(lián)合敏感抗生素治療腰椎術(shù)后早期手術(shù)部位感染并發(fā)膿毒癥[J].中醫(yī)正骨,2023,35(08):70-75.
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病灶清除聯(lián)合敏感抗生素治療腰椎術(shù)后早期手術(shù)部位感染并發(fā)膿毒癥()
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《中醫(yī)正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第35卷
期數(shù):
2023年08期
頁碼:
70-75
欄目:
臨床報道
出版日期:
2023-08-20

文章信息/Info

作者:
李驍騰1郭營1李寶田1呂豐姿2郭小偉1潘玉林1
1.鄭州市骨科醫(yī)院,河南 鄭州 450052; 2.河南省人民醫(yī)院,河南 鄭州 450003
關(guān)鍵詞:
腰椎 膿毒癥 手術(shù)后并發(fā)癥 清創(chuàng)術(shù) 抗生素
摘要:
目的:觀察病灶清除聯(lián)合敏感抗生素治療腰椎術(shù)后早期手術(shù)部位感染并發(fā)膿毒癥的臨床療效及安全性。方法:2015年1月至2021年12月,采用病灶清除聯(lián)合敏感抗生素治療腰椎術(shù)后早期手術(shù)部位感染并發(fā)膿毒癥患者13例,男9例、女4例。年齡 31~58歲,中位數(shù)48歲。所有患者均接受過后路腰椎椎管減壓椎間融合器植骨融合術(shù),其中腰椎間盤突出癥合并腰椎管狹窄癥7例、單純腰椎滑脫癥6例。原手術(shù)節(jié)段為單節(jié)段4例,其中L4~53例,L5S11例; 2節(jié)段6例,其中L3~4、L4~54例,L4~5、L5S12例; 3節(jié)段3例,其中L2~3、L3~4、L4~52例,L3~4、L4~5、L5S11例。感染累及肌層8例,累及椎體、椎間隙5例。感染并發(fā)膿毒癥時間,原手術(shù)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,且局部有滲出物。體溫38.9~40.3 ℃,中位數(shù)39.5 ℃。血培養(yǎng)和穿刺液培養(yǎng)結(jié)果顯示,表皮葡萄球菌3例、金黃色葡萄球菌5例、肺炎克雷伯菌1例、大腸桿菌1例、陰溝腸桿菌3例。記錄病灶清除術(shù)前后白細(xì)胞、C-反應(yīng)蛋白、紅細(xì)胞沉降率、降鈣素原的檢測值,采用Oswestry功能障礙指數(shù)(oswestry disability index,ODI)評價腰椎功能,采用疼痛視覺模擬量表(visual analogue scale,VAS)評價腰部、腿部疼痛情況,采用改良MacNab標(biāo)準(zhǔn)評價綜合療效。隨訪觀察并發(fā)癥發(fā)生和內(nèi)固定物固定等情況。結(jié)果:本組13例患者均采用1次清創(chuàng)手術(shù),均于炎癥控制后1周出院。所有患者均獲隨訪,隨訪時間6~24個月,中位數(shù)14個月。病灶清除術(shù)前、術(shù)后3 d、術(shù)后7 d、術(shù)后14 d的白細(xì)胞計(jì)數(shù)分別為(15.47±7.78)109個·L-1、(12.87±0.14)109個·L-1、(10.28±2.44)109個·L-1、(7.65±0.03)109個·L-1,C-反應(yīng)蛋白檢測值分別為(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,紅細(xì)胞沉降率檢測值分別為(63±20)mm·h-1、(62±16)mm·h-1、(52±14)mm·h-1、(41±11)mm·h-1,降鈣素原檢測值分別為(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。病灶清除術(shù)前、術(shù)后3個月、術(shù)后6個月和末次隨訪時的腰部疼痛VAS評分分別為(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評分分別為(3.08±0.63)分、(0.31±0.63)分、(0.23±0.44)分和(0.08±0.28)分,ODI指數(shù)分別為(72.31±10.09)%、(23.54±5.78)%、(16.92±3.23)%和(13.53±3.28)%。末次隨訪時評價綜合療效,優(yōu)11例、良2例。至末次隨訪時,所有患者均未出現(xiàn)感染復(fù)發(fā)、內(nèi)固定物松動等并發(fā)癥。結(jié)論:病灶清除聯(lián)合敏感抗生素治療腰椎術(shù)后早期手術(shù)部位感染并發(fā)膿毒癥,可以有效控制感染、減輕腰腿部疼痛、恢復(fù)腰椎功能,且安全性較高,同時無需取出內(nèi)固定物。

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更新日期/Last Update: 1900-01-01