Chikawa Takashi, Sakai Toshinori, Bhatia Nitin N, Sairyo Koichi, Utunomiya Risa, Nakamura Masaru, Nakano Shunji, Shimakawa Takeaki, Minato Akira
Department of Orthopedic Surgery, Tokushima Municipal Hospital, Tokushima, Japan.
Br J Neurosurg. 2011 Oct;25(5):621-4. doi: 10.3109/02688697.2010.546902.
Surgical site infection (SSI) is an unfortunate and unpreventable complication of any surgical intervention including spinal surgery. Early deep SSI (EDSSI) after instrumented spinal fusion are particularly difficult to manage due to the implanted, and possibly infected, instrumentation. The purpose of this study is to retrospectively review patients who underwent spinal surgery, investigate the rate of EDSSI, identify patient-related and surgery-related risk factors and to assess the effectiveness of continuous indwelling irrigation on the eradication of these infections. A total of 814 patients (319 women and 495 men) who underwent spinal surgery were enrolled. Mean age at the initial surgery was 57.4 years old. Infections that penetrated the deep fascia within 1 month after the initial operation were considered as EDSSI. The rate of EDSSI, causal organisms, infection management and resolution were studied. Furthermore, we examined the patient-related and the operation-related risk factors. An overall incidence of EDSSI of 1.1% was found. In 177 patients with diabetes mellitus (DM), two patients (1.1%) developed EDSSI. In 28 patients receiving chronic haemodialysis (HD), two patients with infections (7.1%) were identified, which was statistically significantly greater than the other patient populations. Both operative time and intraoperative blood loss were significantly greater in patients with EDSSI than in non-infected patients. Furthermore, the rate of EDSSI in patients undergoing instrumented spinal fusion (3.8%) was significantly higher than that in the other patients. In the nine patients who developed EDSSI, the causal organisms were identified and treated by surgical debridement, antibiotic therapy and continuous indwelling surgical site irrigation. All infections resolved, and no recurrence has been observed at final follow-up. Removal of the instrumentation was required in only one patient. Based on our results, we believe that continuous surgical site irrigation is an effective adjunct in the surgical treatment for early SSI following spinal surgery.
手术部位感染（SSI）是包括脊柱手术在内的任何外科手术干预都可能出现的不幸且难以预防的并发症。器械辅助脊柱融合术后的早期深部手术部位感染（EDSSI）由于植入了可能已被感染的器械，尤其难以处理。本研究的目的是回顾性分析接受脊柱手术的患者，调查EDSSI的发生率，确定患者相关和手术相关的危险因素，并评估持续留置冲洗对根除这些感染的有效性。共有814例接受脊柱手术的患者（319例女性和495例男性）入组。初次手术时的平均年龄为57.4岁。初次手术后1个月内穿透深筋膜的感染被视为EDSSI。研究了EDSSI的发生率、致病微生物、感染管理及转归情况。此外，我们还研究了患者相关和手术相关的危险因素。发现EDSSI的总体发生率为1.1%。在177例糖尿病（DM）患者中，有2例（1.1%）发生了EDSSI。在28例接受慢性血液透析（HD）的患者中，有2例发生感染（7.1%），这在统计学上显著高于其他患者群体。EDSSI患者的手术时间和术中失血量均显著高于未感染患者。此外，接受器械辅助脊柱融合术的患者中EDSSI的发生率（3.8%）显著高于其他患者。在发生EDSSI的9例患者中，通过手术清创、抗生素治疗和持续留置手术部位冲洗确定并治疗了致病微生物。所有感染均得到解决，末次随访时未观察到复发。仅1例患者需要取出器械。根据我们的结果，我们认为持续手术部位冲洗是脊柱手术后早期SSI外科治疗的一种有效辅助手段。
