Ploumis Avraam, Mehbod Amir A, Dressel Thomas D, Dykes Daryll C, Transfeldt Ensor E, Lonstein John E
Twin Cities Spine Center, Minneapolis, MN 55141, USA.
J Spinal Disord Tech. 2008 Jul;21(5):320-3. doi: 10.1097/BSD.0b013e318141f99d.
This study retrospectively reviewed spine surgical procedures complicated by wound infection and managed by a protocol including the use of vacuum-assisted wound closure (VAC).
To define factors influencing the number of debridements needed before the final wound closure by applying VAC for patients with postoperative spinal wound infections.
VAC has been suggested as a safe and probably effective method for the treatment of spinal wound infections. The risk factors for infection resistance and need for debridement revisions after VAC placement are unknown.
Seventy-three consecutive patients with 79 wound infections after undergoing spine surgery were studied (6 of them had recurrence of infection). All patients were taken to the operating room for irrigation and debridement under general anesthesia followed by placement of the VAC with subsequent delayed closure of the wound. Linear regression and t test were used to identify if the following variables were risk factors for the resistance of infection to VAC treatment: timing of clinical appearance of infection, depth of infection (deep or superficial), presence of instrumentation, positive culture for methicillin-resistant Staphylococcus aureus (MRSA) or more than 1 microorganism, age of the patient, and presence of other comorbidities.
There were 34 males and 39 females with an average age of 58.4 years (21 to 82). Once the VAC was initiated, there was an average of 1.4 procedures until and including closure of the wound. The wound was closed an average of 7 days (range 5 to 14) after the placement of the initial VAC on the wound. The average follow-up was 14 months (range 12 to 28). All of the patients but 2 achieved a clean, closed wound without removal of instrumentation at a minimum follow-up of 1 year. Sixty patients had implants (instrumentation or allograft) within the site of wound infection. Thirteen patients had a decompression with exposed dura. Sixty-four infections (81%) presented with a draining wound within the first 6 weeks postoperatively. Sixty-nine infections (87.3%) were deep below the fascia. There was no statistical significance (P>0.05) of all tested risk factors for the resistance of infection to treatment with the VAC system. The parameter more related to repeat VAC procedures was the culture of MRSA or multiple bacteria.
VAC therapy may be an effective adjunct in closing spinal wounds even after the repeat procedures. The MRSA or multibacterial infections seem to be most likely to need repeat debridements and VAC treatment before final wound closure.
本研究回顾性分析了脊柱手术并发伤口感染并采用包括使用负压封闭引流（VAC）在内的方案进行处理的病例。
通过对接受VAC治疗的术后脊柱伤口感染患者应用VAC，确定影响最终伤口闭合前所需清创次数的因素。
VAC已被认为是治疗脊柱伤口感染的一种安全且可能有效的方法。VAC放置后感染抵抗及清创修正需求的危险因素尚不清楚。
对73例脊柱手术后发生79处伤口感染的连续患者进行研究（其中6例感染复发）。所有患者均在全身麻醉下被送至手术室进行冲洗和清创，随后放置VAC，伤口随后延迟闭合。采用线性回归和t检验来确定以下变量是否为感染对VAC治疗产生抵抗的危险因素：感染临床表现的时间、感染深度（深部或浅部）、内固定的存在、耐甲氧西林金黄色葡萄球菌（MRSA）或多种微生物的阳性培养结果、患者年龄以及其他合并症的存在。
男性34例，女性39例，平均年龄58.4岁（21至82岁）。一旦开始使用VAC，直至伤口闭合（包括伤口闭合）平均进行1.4次操作。在伤口首次放置VAC后平均7天（范围5至14天）伤口闭合。平均随访14个月（范围12至28个月）。除2例患者外，所有患者在至少1年的随访中均实现了伤口清洁闭合且未取出内固定。60例患者在伤口感染部位有植入物（内固定或同种异体移植物）。13例患者进行了减压手术，硬脑膜暴露。64例感染（81%）在术后6周内出现伤口引流。69例感染（87.3%）位于筋膜以下深部。所有测试的感染对VAC系统治疗产生抵抗的危险因素均无统计学意义（P>0.05）。与重复VAC操作相关性更高的参数是MRSA或多种细菌的培养结果。
即使在重复操作后，VAC治疗也可能是闭合脊柱伤口的一种有效辅助手段。MRSA或多菌感染似乎最有可能在最终伤口闭合前需要重复清创和VAC治疗。
