Strom Russell G, Pacione Donato, Kalhorn Stephen P, Frempong-Boadu Anthony K
*Department of Neurosurgery, NYU Langone Medical Center, New York, NY; and †Department of Neurosciences, Division of Neurosurgery, Medical University of South Carolina, Charlestown, SC.
Spine (Phila Pa 1976). 2013 May 20;38(12):991-4. doi: 10.1097/BRS.0b013e318285b219.
A retrospective cohort study.
To assess the ability of local vancomycin powder to prevent wound infection after posterior cervical fusion.
Wound infections are a significant source of morbidity and cost associated with spine surgery. Intraoperative application of vancomycin powder to the wound edges has been shown to lower the infection risk after posterior instrumented thoracolumbar fusion. There is little data on the efficacy and safety of local vancomycin powder in cervical spine surgery.
All cases of posterior cervical fusion by a single surgeon were reviewed from 2007 to 2011. Routine application of 1 gram of vancomycin powder was started in August 2009. Baseline characteristics, operative details, and rates of wound infection and pseudarthrosis were compared between untreated patients and those who received vancomycin powder.
A total 171 patients underwent posterior cervical fusion between 2007 and 2011. Baseline and operative variables were similar between untreated patients (n = 92) and those who received vancomycin powder (n = 79). Patients were followed for a minimum of 1 year (range, 1.1-5.7 yr). The infection rate fell from 10.9% to 2.5% (P = 0.0384) following the introduction of vancomycin powder. The untreated and treated groups had similar rates of pseudarthrosis (5.4% vs. 5.1%). No complications attributable to vancomycin powder were identified.
Routine local application of vancomycin powder is a low-cost effective strategy for preventing wound infection after posterior cervical fusion. Further studies are needed to optimize dosing, assess long-term safety, and evaluate use in other spinal operations.
一项回顾性队列研究。
评估局部应用万古霉素粉末预防颈椎后路融合术后伤口感染的能力。
伤口感染是脊柱手术发病和成本的重要来源。术中在伤口边缘应用万古霉素粉末已被证明可降低后路器械辅助胸腰椎融合术后的感染风险。关于局部应用万古霉素粉末在颈椎手术中的疗效和安全性的数据很少。
回顾了2007年至2011年由单一外科医生进行的所有颈椎后路融合病例。2009年8月开始常规应用1克万古霉素粉末。比较未治疗患者和接受万古霉素粉末治疗患者的基线特征、手术细节以及伤口感染和假关节形成率。
2007年至2011年共有171例患者接受了颈椎后路融合术。未治疗患者（n = 92）和接受万古霉素粉末治疗的患者（n = 79）之间的基线和手术变量相似。患者至少随访1年（范围为1.1 - 5.7年）。引入万古霉素粉末后，感染率从10.9%降至2.5%（P = 0.0384）。未治疗组和治疗组的假关节形成率相似（5.4%对5.1%）。未发现与万古霉素粉末相关的并发症。
常规局部应用万古霉素粉末是预防颈椎后路融合术后伤口感染的一种低成本有效策略。需要进一步研究以优化剂量、评估长期安全性并评估其在其他脊柱手术中的应用。
2级。
