| 腰椎间盘术后切口早期脂肪液化或感染的诊治 |
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投稿时间：2013-06-28
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| 作者 | Author | 单位 | Address | E-Mail |
| 管廷进 |
GUAN Ting-jin |
潍坊医学院附属淄博市第一医院骨二科, 山东 淄博 255200 |
The Second Department of Orthopaedics, the First Hospital Affiliated to Weifang Medical College, Zibo 255200, Shandong, China |
tingjin@sina.com |
| 郑良国 |
ZHENG Liang-guo |
潍坊医学院附属淄博市第一医院骨二科, 山东 淄博 255200 |
The Second Department of Orthopaedics, the First Hospital Affiliated to Weifang Medical College, Zibo 255200, Shandong, China |
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| 孙鹏 |
SUN Peng |
潍坊医学院附属淄博市第一医院骨二科, 山东 淄博 255200 |
The Second Department of Orthopaedics, the First Hospital Affiliated to Weifang Medical College, Zibo 255200, Shandong, China |
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| 李兴学 |
LI Xing-xue |
潍坊医学院附属淄博市第一医院骨二科, 山东 淄博 255200 |
The Second Department of Orthopaedics, the First Hospital Affiliated to Weifang Medical College, Zibo 255200, Shandong, China |
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| 期刊信息：《中国骨伤》2014年，第27卷，第5期，第433-436页 |
| DOI：10.3969/j.issn.1003-0034.2014.05.020 |
| 基金项目: |
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中文摘要:
目的：探讨腰椎间盘髓核摘除术后切口早期脂肪液化或感染的原因、诊断要点及处理方法。
方法：自2007年7月至2012年5月，对腰椎间盘髓核摘除术后切口早期脂肪液化或感染的11例患者的临床资料进行回顾性分析。其中男5例，女6例；平均年龄43.1岁，术后切口脂肪液化或感染发病时间平均为术后第5.5天。主要临床表现包括伤口局部疼痛、体温升高、伤口有淡红色或者淡黄色渗液及血炎症生化指标升高等，疗效评估则以伤口是否Ⅰ期愈合为主要标准。
结果：11例患者均获得随访，随访时间平均为1年9个月，10例伤口Ⅰ期愈合，无复发，也无术后并发症出现，1例金黄色葡萄球菌感染患者伤口愈合后2个月，伤口远端局部红肿、隆起，有波动感，穿刺细菌培养为金黄色葡萄球菌，门诊局部切开找到1个线头，换药1周后伤口愈合，随访13个月无复发。
结论：术前对高危因素预防，术中无创操作技术，对于放置内置物的腰椎手术，合理应用抗生素预防感染，术后伤口正确处理，可预防和减少腰椎间盘手术切口脂肪液化或感染的发生率。对切口脂肪液化或感染早期诊断，早期行伤口清创、病灶清除、VSD负压冲洗引流、对伤口分泌物细菌培养结果为阳性者，根据药敏结果选择敏感抗生素治疗，有利于伤口早期愈合，减少手术并发症的发生。 |
| 【关键词】腰椎 外科手术 手术后并发症 脂肪液化 感染 引流术 |
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| Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation |
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ABSTRACT
Objective: To explore the reason,key diagnosic point and therapeutic method of the incisions fat colliquation or infections at early stage after operation of lumbar disc herniation.
Methods: From July 2007 to May 2012,clinical data of 11 patients with incision fat liquefaction or early infection after lumbar discectomy were retrospectively analyzed. There were 5 males and 6 females with an average age of 43.1 years,and the mean time of incisions fat colliquation or infection was 5 days and a half after operation. The main clinical features included local wound pain aggravating,fervescence,fresh seepage in the wound,and blood inflammatory index increased,etc. The wound could heal at the first treatment stage or not was an evaluation standard of curative effect.
Results: All patients were followed up with an average period of 21 months. The wounds of 10 cases healed at the first stage without recurrence and complications. In 1 case infected by staphylococcus aureus,distal part of the wound present local red,swelling and with wave motion at 2 months after operation,staphylococcus aureus infection was confirmed after puncture and bacterial culture,and 1 thrum was found after local incision. The wound healed after change dressings for 1 week,without recurrence after followed up for 13 months.
Conclusion: Preventing the risk factors before operation,minimizing invasive technique during operation reasonable antibiotics application for the lumbar operation reguiring placement objects,and correctly handling with wound after operation could prevent and reduce the incidence of incisions fat liquefaction or infection after operation of lumbar disc herniation. For incision fat liquefaction or infection,early diagnosis,debridement,VSD negative pressure irrigation and drainage,to choosing sensitive antibiotics according to the results of drug sensitivity,may contribute to wound early healing and decrease complication. |
| KEY WORDS Lumbar vertebrae Surgical procedures,operative Postoperative complications Fat colliquation Infection Drainage |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 管廷进,郑良国,孙鹏,李兴学.腰椎间盘术后切口早期脂肪液化或感染的诊治[J].中国骨伤,2014,27(5):433~436 |
| 英文格式: | GUAN Ting-jin,ZHENG Liang-guo,SUN Peng,LI Xing-xue.Surgical treatment for incisions fat colliquation or infections at early stage after operation of lumbar disc herniation[J].zhongguo gu shang / China J Orthop Trauma ,2014,27(5):433~436 |
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