Beiner John M, Grauer Jonathan, Kwon Brian K, Vaccaro Alexander R
Department of Orthopaedic Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, Pennsylvania 19107, USA.
Neurosurg Focus. 2003 Sep 15;15(3):E14. doi: 10.3171/foc.2003.15.3.14.
Postoperative spinal wound infections occur in 1 to 12% of patients. The rate of infection is related to the type and duration of the procedure, comorbidities, nutritional status, and various other risk factors. Antibiotic prophylactic therapy has been clearly shown to decrease the rate of infection dramatically after lumbar surgery. These infections typically manifest with signs and symptoms of wound swelling, erythema, and drainage. Laboratory-detected values such as the erythrocyte sedimentation rate and C-reactive protein can be elevated beyond what is normal for the uncomplicated postoperative course following lumbar surgery, and combined with the clinical symptoms should alert the physician to the possibility of infection. When detected, these infections should be managed aggressively with operative debridment and irrigation, including the deep subfascial layer in all cases except those with clearly demarcated superficial infection. The choice of one versus multiple debridments can be made based on the appearance of the wound, patient factors, and nutritional status. Hardware and incorporated bone graft can be left in place in the majority of cases, adding to stability. Outcomes following aggressive treatment of this complication can be excellent, with no long-term loss of function and complete eradication of the infection.
术后脊柱伤口感染在1%至12%的患者中发生。感染率与手术类型和持续时间、合并症、营养状况以及各种其他风险因素有关。抗生素预防性治疗已被明确证明可显著降低腰椎手术后的感染率。这些感染通常表现为伤口肿胀、红斑和引流的体征和症状。实验室检测值如红细胞沉降率和C反应蛋白可能会升高，超出腰椎手术后无并发症的正常术后病程范围，结合临床症状应提醒医生注意感染的可能性。一旦发现，这些感染应通过手术清创和冲洗进行积极处理，除明显局限于浅表的感染外，所有病例均包括深筋膜下层。选择单次还是多次清创可根据伤口外观、患者因素和营养状况来决定。在大多数情况下，内固定装置和植入的骨移植可以保留，以增加稳定性。积极治疗这种并发症后的结果可能很好，不会有长期功能丧失且感染能完全根除。
