Department of Orthopedic Surgery, Spine and Scoliosis Service, Hospital for Special Surgery/Weill Cornell Medical Center, New York, NY, USA.
Int Orthop. 2012 Feb;36(2):439-44. doi: 10.1007/s00264-011-1427-z. Epub 2011 Dec 10.
Postoperative surgical site infections (SSI) are a frequent complication following posterior lumbar spinal surgery. In this manuscript we review strategies for prevention, diagnosis and treatment of SSI.
The literature was reviewed using the Pubmed database.
We identified fifty-nine relevant manuscripts almost exclusively composed of Level III and IV studies.
Risk factors for SSI include: 1) factors related to the nature of the spinal pathology and the surgical procedure and 2) factors related to the systemic health of the patient. Staphylococcus aureus is the most common infectious organism in reported series. Proven methods to prevent SSI include prophylactic antibiotics, meticulous adherence to aseptic technique and frequent release of retractors to prevent myonecrosis. The presentation of SSI is varied depending on the virulence of the infectious organism. Frequently, increasing pain is the only presenting complaint and can lead to a delay in diagnosis. Magnetic resonance imaging and the use of C-reactive protein laboratory studies are useful to establish the diagnosis. Treatment of SSI is centered on surgical debridement of all necrotic tissue and obtaining intra-operative cultures to guide antibiotic therapy. We recommend the involvement of an infectious disease specialist and use of minimum serial bactericidal titers to monitor the efficacy of antibiotic treatment. In the most cases, SSI can be adequately treated while leaving spinal instrumentation in place. For severe SSI, repeat debridement, delayed closure and involvement of a plastic surgeon may be necessary.
术后手术部位感染（SSI）是腰椎后路脊柱手术后常见的并发症。在本文中，我们回顾了预防、诊断和治疗 SSI 的策略。
使用 Pubmed 数据库对文献进行了回顾。
我们确定了 59 篇相关文献，几乎全部由 III 级和 IV 级研究组成。
SSI 的危险因素包括：1）与脊柱病理和手术过程性质相关的因素和 2）与患者全身健康相关的因素。金黄色葡萄球菌是报告系列中最常见的感染病原体。预防 SSI 的有效方法包括预防性抗生素、严格遵守无菌技术和频繁松开牵开器以防止肌肉坏死。SSI 的表现因感染病原体的毒力而异。通常，疼痛加剧是唯一的表现，并可能导致诊断延迟。磁共振成像和 C 反应蛋白实验室研究有助于确定诊断。SSI 的治疗以彻底清除所有坏死组织和获得术中培养物以指导抗生素治疗为中心。我们建议感染病专家参与，并使用最小系列杀菌滴度来监测抗生素治疗的效果。在大多数情况下，SSI 可以在不取出脊柱内固定的情况下得到充分治疗。对于严重的 SSI，可能需要再次清创、延迟缝合以及整形外科医生的参与。
