Rechtine G R, Bono P L, Cahill D, Bolesta M J, Chrin A M
Department of Orthopaedics and Rehabilitation, University of Florida College of Medicine, Gainesville, FL 32610-0246, U.S.A.
J Orthop Trauma. 2001 Nov;15(8):566-9. doi: 10.1097/00005131-200111000-00006.
To assess the risk of infection in trauma patients undergoing surgical intervention with instrumentation for thoracic and lumbar fractures.
A case series of 235 consecutive patients who sustained thoracic and lumbar fractures seen at Tampa General Hospital in Tampa, Florida between 1986 and 1997.
117 patients of the 235 consecutive patients included in the case series underwent surgical intervention; of these patients, twelve were identified as having acute postoperative wound infections.
Of those patients treated with operative decompression and internal fixation, the authors identified and studied those with an acute wound infection. These patients were analyzed for risk factors and infection management.
Twelve (10 percent) patients with acute postoperative wound infections were identified. These included nine deep and three superficial infections. This provides an overall infection rate of 10 percent (12 of 117). Of these, there were three infections in twenty-one patients undergoing anterior spinal procedures. Only two of the twelve patients had pure cultures of gram-positive organisms (2 Staphylococcus aureus). Cultures from eight (67 percent) patients showed multiple organisms. There was a significantly (P < 0.05) higher risk of infection in the patients with a complete neurologic injury 41 percent (7/17) as compared with those with no deficit or incomplete injuries 5.0 percent (5/100).
The overall risk of infection is higher in the trauma patient than in the elective surgery population. Those patients with a complete neurologic deficit are at a greater risk. Aggressive and early intervention can help contribute to a favorable outcome.
评估接受胸腰椎骨折内固定手术治疗的创伤患者的感染风险。
1986年至1997年期间在佛罗里达州坦帕市坦帕综合医院连续收治的235例胸腰椎骨折患者的病例系列。
病例系列中的235例连续患者中有117例接受了手术治疗；其中，12例被确定为术后急性伤口感染。
在接受手术减压和内固定治疗的患者中，作者识别并研究了发生急性伤口感染的患者。对这些患者进行了危险因素和感染管理分析。
确定了12例（10%）术后急性伤口感染患者。其中包括9例深部感染和3例浅表感染。总体感染率为10%（117例中的12例）。其中，21例接受前路脊柱手术的患者中有3例感染。12例患者中只有2例为革兰氏阳性菌纯培养（2例金黄色葡萄球菌）。8例（67%）患者的培养显示有多种微生物。与无神经功能缺损或不完全损伤的患者5.0%（5/100）相比，完全神经损伤患者的感染风险显著更高（P<0.05），为41%（7/17）。
创伤患者的总体感染风险高于择期手术人群。那些有完全神经功能缺损的患者风险更大。积极早期干预有助于取得良好结果。
