Bose Bikash
Department of Neurosurgery, Christiana Care Health Care System, C-79 Omega Drive, Newark, DE 19713, USA.
Spine J. 2003 Sep-Oct;3(5):394-9. doi: 10.1016/s1529-9430(03)00023-8.
A delayed infection after instrumented spine surgery can be difficult to diagnose because of its low incidence and variety of clinical symptoms.
To describe four cases of delayed infection after instrumented spine surgery and to review the literature of such cases with regard to the clinical symptoms and risk factors, possible causes of infection and treatment.
STUDY DESIGN/SETTING: Personal review of cases and literature review.
Four cases in this report and 93 other cases reported in the literature.
Not measured.
Summary of the clinical symptoms, risk factors, causes of infection and treatment regimens.
Three possible causes of a delayed infection have been cited: intraoperative seeding, metal fretting causing a sterile inflammatory response or stimulating low-virulent organisms to fester and hematogenous seeding. A variety of clinical symptoms were found, but spontaneous drainage appears to be most common. Many patients had either a fluctuant mass, localized drainage or an abscess. Abscesses or drainage material is typically contiguous with the instrumentation and the fusion mass. Fever was present in only six patients. Effective treatment usually includes removal of the implants, irrigation and debridement, followed by the administration of antibiotics.
A high level of suspicion is needed to diagnose a delayed infection after instrumented spine surgery.
由于脊柱内固定手术后延迟感染的发病率较低且临床症状多样，其诊断可能会很困难。
描述四例脊柱内固定手术后延迟感染的病例，并就此类病例的临床症状、危险因素、可能的感染原因及治疗方法进行文献综述。
研究设计/研究背景：病例个人回顾及文献综述。
本报告中的四例病例及文献报道的其他93例病例。
未测量。
总结临床症状、危险因素、感染原因及治疗方案。
延迟感染有三种可能原因：术中播散、金属微动引起无菌性炎症反应或刺激低毒力微生物化脓以及血行播散。发现了多种临床症状，但自发引流似乎最为常见。许多患者有波动感肿块、局部引流或脓肿。脓肿或引流物通常与内固定器械及融合块相邻。仅六例患者出现发热。有效的治疗通常包括取出植入物、冲洗和清创，随后使用抗生素。
诊断脊柱内固定手术后延迟感染需要高度怀疑。
