Weinstein M A, McCabe J P, Cammisa F P
Spine Service at the Hospitalfor Special Surgery, New York, New York, USA.
J Spinal Disord. 2000 Oct;13(5):422-6. doi: 10.1097/00002517-200010000-00009.
Postoperative infection remains a troublesome but not uncommon complication after spinal surgery. Most previous reports, however, are small or involve cases with more than one surgeon often at different institutions. This study represents a single surgeon's 9-year experience with postoperative infection at one institution. The authors describe the features of wound infection after spinal surgery with reference to diagnosis, microbiology, and treatment and they describe a protocol for effective management of postoperative spinal wound infection. The records of the senior author (F.P.C.) during a 9-year period for cases of postoperative wound infection were reviewed. Of 2,391 operative procedures, 46 cases of wound infection were identified, yielding an overall infection rate of 1.9%. Patients' preoperative risk factors, original diagnosis prompting the surgery, onset of infection, presentation, treatment, and outcome were analyzed. The mean age of the 23 men and 23 women was 57.2 years. The preoperative diagnoses included lumbar degenerative scoliosis or spinal stenosis in 28 cases, disk prolapse in 8 cases, metastatic disease in 4 cases, degenerative disk disease in 1 case, and a group of 5 miscellaneous cases. Seventeen (37%) of the patients underwent at least one previous spinal surgery at the same site. Twenty-three patients had a fusion, of whom 22 also had instrumentation. Forty-three (93%) of the patients had significant wound drainage after an average of 15 days (range, 5-80 days). The other three patients were examined approximately 2 years after the surgery. Fourteen of the patients also had pyrexia (temperature >37.5 degrees C) at presentation. Staphylococcus aureus alone was cultured in 29 patients, whereas another six patients had a different single organism. In nine patients, more than one organism was cultured during their hospital stay. Surgical treatment included primary closure in only seven patients, with most undergoing wound drainage and debridement followed by delayed closure. Instruments were removed in the three patients with late presentation who had solid fusion at operation. Viable bone graft and instrumentation were left in situ in all patients who were seen before fusion. All wounds healed without sequelae, except for three that required flap closure. Pseudarthrosis was noted in three patients after more than 1 year of follow-up in this series. Postoperative spinal wound infection is a potentially devastating problem. In this series, infection was more common in patients undergoing fusion with instrumentation and in patients with cancer metastatic to the spine. An aggressive surgical approach, including repeated debridement followed by delayed closure, is justified. Instrumentation may be safely left in situ to provide stability for fusion.
术后感染仍是脊柱手术后一个棘手但并不罕见的并发症。然而，以往大多数报告样本量较小，或涉及多位外科医生（通常来自不同机构）的病例。本研究展示了一位外科医生在一家机构9年中处理术后感染的经验。作者描述了脊柱手术后伤口感染在诊断、微生物学及治疗方面的特点，并阐述了有效管理术后脊柱伤口感染的方案。回顾了资深作者（F.P.C.）9年间术后伤口感染病例的记录。在2391例手术中，共识别出46例伤口感染病例，总体感染率为1.9%。分析了患者的术前危险因素、促使手术的原发病诊断、感染的发生时间、表现、治疗及结果。23名男性和23名女性患者的平均年龄为57.2岁。术前诊断包括腰椎退变性脊柱侧凸或椎管狭窄28例、椎间盘突出8例、转移性疾病4例、退变性椎间盘疾病1例以及5例杂类病例。17例（37%）患者此前在同一部位至少接受过一次脊柱手术。23例患者进行了融合手术，其中22例还进行了内固定。43例（93%）患者在平均15天（范围5 - 80天）后出现明显伤口引流。另外3例患者在手术后约2年接受检查。14例患者就诊时还伴有发热（体温>37.5℃）。仅29例患者培养出金黄色葡萄球菌，另外6例患者培养出另一种单一微生物。9例患者住院期间培养出不止一种微生物。手术治疗方面，仅7例患者进行了一期缝合，大多数患者先进行伤口引流和清创术，随后进行延迟缝合。3例就诊较晚且术中已实现牢固融合的患者取出了内固定。在融合前就诊的所有患者中，均保留了存活的骨移植材料和内固定装置。除3例需要皮瓣闭合的伤口外，所有伤口均愈合且无后遗症。在本系列随访1年以上的患者中，有3例出现了假关节形成。术后脊柱伤口感染是一个潜在的严重问题。在本系列中，感染在接受融合内固定手术的患者以及脊柱转移癌患者中更为常见。采取积极的手术方法，包括反复清创术随后延迟缝合是合理的。内固定装置可安全地留在原位，为融合提供稳定性。
