【作者】 杨扬；

【导师】 张建新；

【作者基本信息】 山东中医药大学 ， 中医骨伤科学（专业学位）， 2021， 硕士

【摘要】 目的:探讨中医外科托法联合病灶清除与持续冲洗引流治疗腰椎化脓性感染的临床疗效,为中西医结合治疗腰椎化脓性感染的提供新思路。方法:采用病例系列研究对2018年7月～2020年6月山东中医药大学附属医院收治的中医外科托法联合病灶清除与持续冲洗引流治疗的11例腰椎化脓性感染患者住院病例资料进行回顾性分析。统计所有患者围手术期资料及随访情况:比较VAS评分、腰椎JOA评分与感染相关指标的变化情况;采用腰椎X线、CT及MRI等检查进行影像学方面评价。应用SPSS 21软件进行统计学分析。结果:所有患者随访9～24个月,平均(15.55±4.23)个月。所有患者均顺利完成手术,手术时间80～330min,平均(158.18±68.38)min;出血量40～600ml,平均(235.45±175.86)ml;冲洗天数5～25d,平均(14.91±5.74)d;引流天数5～26d,平均(16.73±6.03)d;静脉应用抗生素天数16～56d,平均(27.64±12.35)d;术后住院天数17～64d,平均(31.64±14.07)d。临床病原学诊断为金黄色葡萄球菌2例,耐甲氧西林表皮葡萄球菌、表皮葡萄球菌、人型葡萄人型亚种、琼氏不动杆菌、门多萨假单胞菌、产气肠杆菌及大肠埃希菌各1例,细菌培养阴性2例。在随访过程中,所有患者VAS评分随时间的推移逐渐降低,术后随访各时间点与术前相比,差异具有统计学意义(P<0.05);腰椎JOA评分随随访时间推移而逐渐升高,术后随访各时间点与术前相比,差异具有统计学意义(P<0.05)。所有患者末次随访时感染相关指标均降至正常值范围内。影像学方面,行椎间植骨融合的6例患者已获骨性融合,术后有内固定的8例患者中,除1例行二次清创取出内固定物外,余7例患者内固定物均稳定、无松动;所有患者经一期治疗感染治愈率72.73%,经二期治疗感染治愈率100%,所有患者至末次随访时均未见感染复发表现。结论:(1)在感染病灶彻底清除后进行冲洗引流是治疗腰椎化脓性感染有效的治疗方法;(2)对于腰椎内固定术后手术部位感染,早期诊断后尽早行手术清创与冲洗引流治疗,可获得满意疗效并增加内植物的保留率;(3)腰椎化脓性感染的中医治疗可以参考中医外科流注理论,以中医外科托法为内治法则,配合中药汤剂干预,联合西医常规治疗手段,可取得满意的临床疗效。更多还原

【Abstract】 Objective: To explore the clinical efficacy of Tuo Method in TCM Surgery combined with debridement and continuous irrigation and drainage in the treatment of pyogenic lumbar infection,so as to provide a new idea for the combination of traditional Chinese and western medicine in the treatment of pyogenic lumbar infection.Methods: The data of 11 inpatients with pyogenic lumbar infection treated by Tuo Method in TCM Surgery combined with debridement and continuous irrigation and drainage from July 2018 to June 2020 in the affiliated Hospital of Shandong University of TCM were analyzed retrospectively.Statistics of perioperative data and follow-up of all patients: the changes of VAS score,lumbar JOA score and infection related indexes were compared,and lumbar X-ray,CT and MRI were used for imaging evaluation.SPSS 21 software was used for statistical analysis.Results: All patients were followed up for 9 to 24 months,with an average of(15.55 ± 4.23)months.The operation time was 80～330min,with an average of(158.18 ± 68.38)min;the amount of bleeding was 40～600ml,with an average of(235.45 ± 175.86)ml;the days of washing were 5～25d,with an average of(14.91 ± 5.74)d;the days of drainage were 5～26d,with an average of(16.73 ± 6.03)d;the days of intravenous antibiotics were 16～56d,with an average of(27.64 ± 12.35)d;the days of postoperative hospitalization were 17 ～ 64 d,with an average of(31.64±14.07)d.Clinical etiological diagnosis was Staphylococcus aureus in 2 cases,methicillin-resistant Staphylococcus epidermidis,Staphylococcus epidermidis,Staphylococcus hominis subsp.Hominis,Acinetobacter Jones,Pseudomonas Mendoza,Enterobacter aerogenes and Escherichia coli in 1 case,and bacterial culture negative in 2 cases.During the follow-up,the VAS scores of all patients gradually decreased with the passage of time,and the difference was statistically significant(P < 0.05);the lumbar JOA scores gradually increased with the passage of time,and the difference was statistically significant(P < 0.05).At the last follow-up,the infection related indexes of all patients were reduced to the normal range.In terms of imaging,6 patients with interbody fusion have achieved bone fusion,8 patients with internal fixation after operation,except for 1 case of secondary debridement and removal of internal fixation,the internal fixation of the remaining 7 patients were stable without loosening;the cure rate of infection in all patients was72.73% after one-stage treatment and 100% after two-stage treatment,and no infection was re published in all patients until the last follow-up Now.Conclusion:(1)It is an effective method to treat pyogenic lumbar infection by continuous irrigation and drainage after the infection focus is completely removed.(2)For the surgical site infection after lumbar internal fixation,surgical debridement and continuous irrigation and drainage should be performed as soon as possible after early diagnosis.(3)TCM treatment of pyogenic lumbar infection can refer to the theory of traditional Chinese medicine surgery-LIUZHU,take the Tuo Method in TCM Surgery as internal treatment rule,cooperate with TCM Decoction intervention,combined with western medicine conventional treatment,can achieve satisfactory clinical effect.更多还原