Richards B R, Emara K M
Department of Orthopaedics, Texas Scottish Rite Hospital for Children, Dallas, Texas 75219, USA.
Spine (Phila Pa 1976). 2001 Sep 15;26(18):1990-6. doi: 10.1097/00007632-200109150-00009.
To determine the incidence of delayed infections in idiopathic scoliosis treated with TSRH instrumentation, proper wound management after instrumentation removal, and whether the previously identified bacterial trend remains consistent.
All patients with idiopathic scoliosis > or =2 years after surgery with posterior TSRH instrumentation were included. Those cases with delayed infections were retrospectively reviewed. Time of presentation (infection) from index operation, clinical picture, sedimentation rate, presence of pseudarthrosis, organisms grown on culture, type of wound closure, and duration of antibiotics were examined.
A total of 489 patients were identified > or =2 years postoperation; 23 had delayed infections (4.7%). Time of presentation averaged 27 months after initial surgery. Spontaneous drainage occurred in 15 patients, fluctuance in 6, and neither in the remaining 2 (pain and fever). Sedimentation rate averaged 48 mm/hr. All patients had instrumentation removed. Primary closure (1 stage) was performed in 14 patients, and delayed primary closure (> or =2 stages) was performed in nine patients. All wounds healed uneventfully. Cultures at the time of instrumentation removal grew Propionibacterium acnes in 12 patients, Staphylococcus epidermidis (or Staphylococcus coagulase-negative) in 4, Micrococcus varians in 1, and Staphylococcus aureus in 1. Five patients had negative cultures. After removal, patients received parenteral antibiotics; in 21 of these patients this was followed by oral antibiotics.
Low-virulent skin organisms are primarily responsible for delayed infections. Intraoperative seeding followed by subclinical quiescent periods appears to be the method by which infection occurs. The increased bulk and modularity of modern instrumentation systems can lead to inflammation and bursa formation, thus contributing significantly to the activation of these infections. Primary wound closure results in successful wound healing. Delayed closure after 48 hours is unnecessary. Short-term postoperative parenteral antibiotics (2-5 days) followed by short-term oral antibiotics (7-14 days) is recommended.
确定使用TSRH器械治疗特发性脊柱侧凸后延迟感染的发生率、器械取出后的伤口妥善处理方法，以及之前确定的细菌趋势是否保持一致。
纳入所有接受后路TSRH器械手术且术后≥2年的特发性脊柱侧凸患者。对延迟感染的病例进行回顾性分析。检查从初次手术到出现（感染）的时间、临床表现、血沉、假关节的存在情况、培养出的微生物、伤口闭合类型以及抗生素使用时间。
共确定489例术后≥2年的患者；23例发生延迟感染（4.7%）。出现感染的平均时间为初次手术后27个月。15例患者出现自发引流，6例有波动感，其余2例（疼痛和发热）均未出现上述情况。血沉平均为48mm/hr。所有患者均取出了器械。14例患者进行了一期缝合，9例患者进行了延迟一期缝合（≥2期）。所有伤口均愈合良好。器械取出时的培养结果显示，12例患者培养出痤疮丙酸杆菌，4例为表皮葡萄球菌（或凝固酶阴性葡萄球菌），1例为变异微球菌，1例为金黄色葡萄球菌。5例患者培养结果为阴性。取出器械后，患者接受了静脉抗生素治疗；其中21例患者随后接受了口服抗生素治疗。
低毒力皮肤微生物是延迟感染的主要原因。术中植入并随后经历亚临床静止期似乎是感染发生的方式。现代器械系统体积增大和模块化程度提高可导致炎症和滑囊形成，从而显著促进这些感染的激活。一期伤口闭合可实现伤口成功愈合。48小时后进行延迟闭合没有必要。建议术后短期使用静脉抗生素（2 - 5天），随后短期使用口服抗生素（7 - 14天）。
