Sponseller P D, LaPorte D M, Hungerford M W, Eck K, Bridwell K H, Lenke L G
Department of Orthopaedic Surgery, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287-0882, USA. psponse@.jhmi.edu
Spine (Phila Pa 1976). 2000 Oct 1;25(19):2461-6. doi: 10.1097/00007632-200010010-00007.
A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed.
To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment.
No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients.
After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal.
Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative Staphylococcus, Enterobacter, Enterococcus, and Escherichia coli.- Debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012).
Patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. Patients in whom infection develops are then at increased risk for pseudarthrosis.
开展了一项回顾性病例对照研究，评估接受脊柱侧弯融合手术的脑瘫或脊髓脊膜膨出患者的感染危险因素、致病微生物及治疗结果。
确定感染的危险因素，并根据感染微生物及对治疗的反应来描述感染情况。
此前尚无研究分析该组患者感染的危险因素或致病微生物，也未表明感染的治疗结果。
对210例接受手术治疗的患者进行10年回顾性研究，16例脊髓脊膜膨出患者和9例脑瘫患者发生了深部伤口感染。对这些患者以及50例年龄、诊断和手术年份匹配的未感染患者进行了广泛的可能危险因素研究。进行统计学检验以确定危险因素。根据分离出的微生物及对治疗的反应来描述感染过程。治疗采用逐步方式进行，并根据最成功的步骤进行分类：清创缝合、棒上形成肉芽组织或取出内固定器械。
在检测的10个危险因素中，有2个被发现具有显著性：认知障碍程度和同种异体移植物的使用。结果显示，52%的感染为多微生物感染。革兰氏阴性菌与革兰氏阳性菌分离情况相同。最常见的微生物是凝固酶阴性葡萄球菌、肠杆菌、肠球菌和大肠杆菌。25例深部伤口感染患者中，11例清创缝合成功。在14例经连续清创缝合仍未解决感染的患者中，2例通过让伤口在棒上形成肉芽组织成功处理，7例因伤口持续引流需要取出棒。有3例有症状的假关节。革兰氏阳性菌引起的感染最常通过清创缝合成功处理（P = 0.012）。
患有严重认知障碍的脑瘫或脊髓脊膜膨出患者以及接受同种异体移植物的患者感染风险可能增加。与择期骨科手术相比，感染更常为多微生物感染且由革兰氏阴性菌引起。这提示有肠道来源。清创缝合治疗并不总是成功。发生感染的患者假关节风险增加。
