腰椎金属支架固定术后移植物感染一例报告并文献复习

摘要

Objective To explore clinical characteristics, key points of diagnosis and treatment of implant infections. Methods Clinical data of one patient with implant infection were retrospectively analyzed and related literature was also re-viewed. Results The patient was admitted for abdominal pain, lumbago and fever and was examined with ultrasonography, CT and laboratory testing in other institutions, for intestinal obstruction. The patient received treatment of gastrointestinal de-compression and antibiotics, but his symptoms had no mitigation. After being admitted to our emergency department, the pa-tient was examined with pathogen and MRI. Combining with the history of lumbar metal stents fixation, clinicians revised the diagnosis to psoas abscess and hematoma, and spine implant infection was suspected. The patient received treatments inclu-ding topical percutaneous puncture catheter drainage, anti-infection treatment according to the results of blood culture and drug sensitivity, intravenous fluids, abatement of fever and other symptomatic therapy, the symptoms were alleviated. The patient family insisted that the patient be sent back to a local hospital for treatment. Clinical follow up for one month revealed that de-finitive diagnosis was implant infection after lumbar metal stents fixation. After the patient underwent surgery to remove the im-plant combined with anti-infection therapy based on pathogen-detecting results, the patient recovered. Conclusion The early clinical manifestation of implant infections lacks specificity, and the disease is apt to be misdiagnosed. After eliminating other common suspected causes of infection, clinicians should consider the possibility of the disease when the patient has unex-plained symptoms of systemic infection and the medical history of implant infection. Relevant inspections should be carried in time in order to make an early diagnosis of the disease.%目的：探讨移植物感染的临床特点及诊治要点。方法对我院收治的1例脊柱移植物感染的临床资料进行回顾性分析。结果本例因腰腹疼痛伴发热入院。曾于外院行超声、CT、实验室检查，按肠梗阻予胃肠减压、抗感染等治疗，症状无明显缓解。入我院急诊科后完善病原学、MR 检查，结合既往腰椎金属支架固定术史，修正诊断为腰大肌脓(血)肿，考虑脊柱移植物感染所致。予局部穿刺置管引流，针对血培养、药敏试验结果予抗感染、补液、退热等对症支持治疗，症状缓解，家属要求回当地治疗。1个月后随访，当地医院确诊为腰椎金属支架固定术后移植物感染。予手术移除移植物并结合病原学检测结果予抗感染治疗后痊愈。结论移植物感染早期临床表现缺乏特异性，易误诊。提示对于有原因不明的全身感染症状、有移植物手术史的患者，在排除其他常见感染病因后，应考虑移植物感染的可能，宜完善相关检查，尽早确诊。