胸腰椎椎板切除减压术后中枢神经系统感染及其危险因素

Central nervous system infection after thoracolumbar spinal laminectomy and decompression surgery and risk factors analysis

中文关键词:  中枢神经系统感染  胸腰椎手术  危险因素

英文关键词:Central nervous system infection  Thoracolumbar spinal surgery  Risk factor

中文摘要:

  【摘要】 目的：分析胸腰椎椎板切除减压术后中枢神经系统感染及其危险因素。方法：2015年6月~2018年9月于我院接受后路椎板切除减压手术的患者共2632例，其中8例出现术后中枢神经系统感染，男5例，女3例，年龄为55.8±9.3岁（41～69岁）。8例均出现高热，7例出现头痛，4例出现不同程度意识障碍，7例出现颈抵抗。除1例患者血白细胞计数正常，其余患者的血白细胞计数、C反应蛋白及血沉均升高。8例脑脊液检查均表现为白细胞显著增加、葡萄糖降低、蛋白升高，1例患者脑脊液及血液细菌培养为金黄色葡萄球菌阳性，其余患者细菌培养均为阴性。8例患者头部CT均无异常。1例患者胸椎MRI提示切口深部感染，1例腰椎MRI提示硬膜内脑脊液异常T2WI信号改变。记录8例患者的治疗及随访结果。根据是否发生术后中枢神经系统感染将患者分为两组，使用卡方检验分析两组患者的术前诊断、手术时间、术中出血量、手术节段、留置引流管时间、是否发生硬膜撕裂及手术部位感染等因素是否存在统计学差异。结果：1例切口深部感染患者行清创手术，8例患者均接受18.50±3.07d（14～24d）抗生素治疗后症状及体征完全消失，血常规、C反应蛋白及血沉正常。随访20.50±8.19个月（12～36个月），所有患者至末次随访时均无发热、头痛、颈抵抗或意识障碍，血常规、C反应蛋白及血沉均正常。卡方检验显示手术节段≥3及硬膜撕裂在两组患者间存在显著性差异（P<0.05），其余因素两组间无显著性差异（P>0.05）。结论：术后中枢神经系统感染是胸腰椎椎板切除减压手术后罕见的并发症。当胸腰椎椎板切除减压手术后患者出现发热、头痛、颈抵抗和意识障碍时应尽快实施腰穿脑脊液检查，早期诊断和及时应用抗生素治疗可获得良好的结果。手术节段≥3及硬膜撕裂与发生术后中枢神经系统感染密切相关。

英文摘要:

  【Abstract】 Objectives: To analyze the central nervous system infection(CNSI) after thoracolumbar spinal laminectomy and decompression surgery and its risk factors. Methods: From June 2015 to Sep 2018, we retrospectively reviewed 2,632 patients underwent thoracolumbar spinal laminectomy and decompression surgery. 8 patients (5 males, 3 females) were diagnosed of postoperative CNSI according to the clinical features and cerebrospinal fluid (CSF) analysis, and the average age was 55.8±9.3(41-69) years old. 8 patients had fever, 7 had headache, 7 had neck stiffness and 4 had consciousness disturbance. The white blood cell count, C-reactive protein and erythrocyte sedimentation rate increased in all patients except one patient whose white blood cell count was normal. The CSF study demonstrated elevated white blood cell count, glucose decrease and protein increase in all patients. Bacterial cultures of all patients were negative except one patient with positive blood and CSF cultures. There was no abnormality in encephalo CT in 8 patients. One thoracic MRI showed deep incision infection and one lumbar MRI showed abnormal T2WI high signal of intradural cerebrospinal fluid. The treatment and follow-up results of 8 patients were recorded. Patients were divided into 2 groups according to whether postoperative CNSI occurred or not. Preoperative diagnosis, operation time, intraoperative bleeding, surgical segment, time of drainage removal, dural tear(DT) and surgical site infection(SSI) were recorded, and the Chi-square test was used to analyze the statistic differences between the 2 groups. Results: All 8 patients received 18.50±3.07(14-24) days of antibiotic treatment, except 1 patient who accepted debridement. All patients showed symptoms and signs disappeared completely, blood routine test, C-reactive protein and erythrocyte sedimentation rate normal before being discharged from hospital. The average follow-up was 20.50±8.19 months(12-36 months), and there was no fever, headache, neck resistance or consciousness disturbance; Blood routine, C-reactive protein and erythrocyte sedimentation rate were normal at the last follow-up. Chi square test showed that there were significant differences between the two groups in surgical segment and DT (P<0.05), while there were no significant differences in other factors(P>0.05). Conclusions: Postoperative CNSI is a rare complication after thoracolumbar spinal surgery. A highly suspicion should be maintained in patients with the clinical manifestations of fever, headache, neck stiffness and consciousness disturbance. Lumbar puncture and CSF study are necessary for suspicious patients. An early diagnosis and appropriate antibiotic treatment can lead to a good outcome. Surgical segment≥3 and DT were significantly correlated with CNSI.