Lumbar Spinal Internal Fixation Of Postoperative Incision Infection Clinical Case Study

ObjectiveBased on the retrospective study of the clinical cases of the wound infection in the lumbar internal fixation postoperation for more than ten years in our department.Analyze the risk factor for the postoperation of wound infection.probe into the early diagnostic points for the postoperation of wound infection,and The Chinese Medicine’s application and research in this field.summarize the treatment in vary degrees of the postoperation of wound infection.Provide the basis for the treatment and diagnosis of the postoperation of wound infection in our clinical work.MethodsSystematic summary the predisposing factors.the diagnostic and the therapeutic methods of the wound infection in the lumbar internal fixation postoperation,as well as the research on The Chinene Medicine in the part of literature research.In the clinical research part,based on the retrospective study of the17clinical cases of the wound infection in the lumbar internal fixation postoperation from Jan.2001to Feb.2013,Through the personal characteristics and the surgery study the predisposing factors,Summarized the main factors leading to the infection of the lumbar postoperation in our department, namely, risk factors.Through the patients with biochemical indicators, clinical manifestations and imaging data to investigate postoperative infection diagnostic points.Through the patients with improvement of symptoms and prognosis to evaluate the curative effect of the treatment.According to whether the wound could heal properly as a evaluation standard of curative effect.ResultsData7males and10females, age27-81years, mean age60years; body mass index is22.3-31.6, average26.8. fixation in all patients are titanium alloy materials, surgical methods are posterior lumbar pedicle screw fixation, infection onset after4-17days, an average of8days after surgery.The main clinical features including backleg pain aggravating,fervescence. fresh seepage from the wound,and blood inflammatory index increased, etc.Treatment methods including reoperation intervertebral space lavaging, wound dressing drainage, Chinese Medicine intervention, etc. In the17cases of wound infection patient’s general condition, older than60is10cases, obese is7cases,12cases suffering from underlying diseases, including8diabetes and2rheumatoids, surgery segment is greater than3is5cases, intraoperative blood loss greater than1000ml is5cases, operation time more than3hours is9cases; prophylactic use of antibiotics unreasonable is8cases, like antibiotics are not used in the induction of anesthesia, or in combination with the use of antibioticssurgery a long time without additional antibiotic and so on. Clinical features of11patients with body temperature consistently higher than38.0℃, including2cases higher than39℃,12cases of incisional pain,16cases of blood prompted leukocyte, neutrophil percentage increased,16cases of ESR to speed up,17cases of CRP increased,17patients underwent X-ray,1case of CT,7cases of MRI,7cases of B-ultrasound. The methods of treatment,14patients with secondary surgery intervertebral space perfusion flush,3cases of change of dressing,6cases of Chinese intervention, all patients were followed up after discharge, with an average follow-up time of more than1year.16cases of normal wound healing, recurrence, and no complications, the average healing time of16days, and1patient follow-up repeatedly debridement, treatment of7months, and eventually remove the internal fixation of wound healing.Conclusion1Lumbar spine after internal fixation of wound infection predisposing factors are divided into personal factors and perioperative factors.Personal factors including age above60years, obesity, a history of underlying diseases, such as rheumatoid arthritis and diabetes, long history of smoking, etc. The perioperative factors include the operation time is too long, the surgery segment, the amount of bleeding, wound drainage after surgery for a long time, the prophylactic use of antibiotics unreasonable, etc. Comparison of the frequency of occurrence in predisposing factors in our department postoperative infection, summed up the high age, obesity, previous history of diabetes, long operation time and the use of prophylactic antibiotics unreasonable are the risk factors after internal fixation of the lumbar spine wound infection.2To prevent wound infection, and lower infection rates. First fo all. sterile concept of the medical staff should be strengthened, and enhance sterile operating room management, then strict control of predisposing factors, especially risk factors. For example, preoperative blood glucose and blood pressure control within reasonable limits, and require smokers to quit smoking, stop taking hormones, anti-clotting drugs, prophylactic use of antibiotics during the induction of anesthesia, surgery as small as possible soft tissue injury, bleeding completely, you can use saline to wash the wound, postoperative attention to keep the incision clean and dry, and regularly observe the healing of the incision, as far as possible to shorten the patient’s hospital stay, etc.3The early diagnosis of wound infection points:clinical performance as the starting point to the postoperative continuous moderate heat or ardent fever that will not come back, pain diminished, increased wound exudate, combined with blood count, ESR, CRP and ultrasound or MRI to further clarify the diagnosis. The Chinese Medical could from the sore to analysis wound infection.4The wound infection treatment:The treatment of superficial infection, use of sensitive antibiotics, dressing clean the wound in a timely manner and clear the wound bleeding, oozing, if necessary, remove the part of the incision suture. The deep infection treatment, as early as possible after diagnosis of surgical debridement and intervertebral Irrigation treatment, to obtain satisfactory efficacy and ultimately retained internal fixation.5Lumbar internal fixation postoperative infection can refer to the theory of Chinese medicine surgery sore, based on it to diagnosis and treatment, with traditional Chinese medicine decoction intervention, can improve the body’s resistance to improve the clinical symptoms.