Jones G Alexander, Butler John, Lieberman Isador, Schlenk Richard
Cleveland Clinic Spine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Neurosurg Spine. 2007 May;6(5):407-11. doi: 10.3171/spi.2007.6.5.407.
Deep infections of the spine are a significant cause of morbidity and death. Such infections complicate 0.7 to 11.9% of spinal procedures. Management includes intravenous antibiotic therapy, debridement and irrigation with primary closure, placement of drains, use of irrigation systems, and/or healing through secondary intention with wound packing. Vacuum-assisted closure (VAC) is a new alternative for treatment of patients with complex postoperative spinal infections. The aim of this study was to investigate the safety of this treatment method in this patient population.
The authors reviewed the charts of 16 consecutive patients treated with negative-pressure wound therapy at their institution between 2002 and 2006. All had deep infections of the spine and were treated with surgical debridement and placement of VAC dressings. All infections were postoperative. Members of the infectious disease service were involved in the care of all patients, and all patients received intravenous antibiotic therapy. The authors reviewed operative notes, discharge summaries, and notes from follow-up visits and assessed outcome on the basis of the same records. Three patients were lost to follow up, leaving a group of 13 with follow up of at least 90 days. Two patients experienced bleeding complications related to the continuous negative pressure of the VAC device. In two cases, the infections persisted and required reoperation. In one case, a skin graft was required because of nonhealing granulation tissue. One of the patients with bleeding complications died as a result of delayed complications related to intraoperative blood loss, blood loss via the VAC system, and refusal of a blood transfusion on religious grounds.
Negative-pressure wound therapy has been employed as a treatment strategy for patients with complex postoperative spinal infections, but little is known of the complications associated with VAC in the spinal surgery patient population. Serious complications, including death, may be associated with use of the VAC system.
脊柱深部感染是发病和死亡的重要原因。此类感染使0.7%至11.9%的脊柱手术出现并发症。治疗方法包括静脉抗生素治疗、清创冲洗并一期缝合、放置引流管、使用冲洗系统和/或二期愈合并填塞伤口。负压封闭引流（VAC）是治疗复杂术后脊柱感染患者的一种新方法。本研究的目的是调查该治疗方法在这类患者中的安全性。
作者回顾了2002年至2006年间在其机构接受负压伤口治疗的16例连续患者的病历。所有患者均有脊柱深部感染，并接受了手术清创和VAC敷料放置。所有感染均为术后感染。感染病科成员参与了所有患者的护理，所有患者均接受静脉抗生素治疗。作者回顾了手术记录、出院小结和随访记录，并根据这些记录评估结果。3例患者失访，剩余13例患者随访至少90天。2例患者出现与VAC装置持续负压相关的出血并发症。2例患者感染持续存在，需要再次手术。1例患者因肉芽组织不愈合需要植皮。1例出血并发症患者因术中失血、通过VAC系统失血以及因宗教原因拒绝输血导致的延迟并发症死亡。
负压伤口治疗已被用作治疗复杂术后脊柱感染患者的一种治疗策略，但对于脊柱手术患者中与VAC相关的并发症知之甚少。使用VAC系统可能会出现包括死亡在内的严重并发症。
