Scott & White Healthcare, Temple, TX 76508, USA.
Spine (Phila Pa 1976). 2013 Jun 15;38(14):1183-7. doi: 10.1097/BRS.0b013e31828fcfb5.
Retrospective comparative study using prospectively collected data.
To compare the rate of infection with and without the use of vancomycin powder application during posterior cervical instrumentation.
Surgical site infections (SSI) are a significant source of morbidity in multilevel posterior-instrumented fusions for cervical spondylotic myelopathy (CSM). Local delivery of antibiotics has been associated with decreased rates of SSI in posterior-instrumented fusions, but no study has addressed the effects of these measures on a population composed of exclusively multilevel posterior cervical instrumentation performed with decompression for CSM.
All patients undergoing multilevel posterior decompression and instrumentation for CSM by a single surgeon from 2003-2011 were included. Post hoc analysis of prospectively collected data was analyzed comparing consecutive patients treated without the use of vancomycin powder with those treated after the initiation of vancomycin powder prophylaxis. Intervention cohort and controls were examined for differences in SSI rate, body mass index, neurological status, comorbidities, and complications.
A total of 112 patients were included in the study. Intervention (n = 40) and control (n = 72) groups were statistically similar with regard to age, body mass index, comorbidities, estimated blood loss, and operative time. Univariate analysis showed a significant decrease in infection rate in the intervention group (0%) compared with the control group (15%) in this high-risk population (P = 0.007; power = 81%). No adverse events were noted in the intervention group associated with the use of vancomycin powder.
The local application of vancomycin was associated with a significant reduction in the risk of SSI in multilevel posterior cervical-instrumented fusions for CSM. This study supports the growing body of evidence that vancomycin powder placed in the wound can reduce the incidence of postoperative wound infections, and is the first that addresses this specific population.
使用前瞻性收集的数据进行回顾性比较研究。
比较后路颈椎器械固定术中使用万古霉素粉末与不使用万古霉素粉末的感染率。
手术部位感染（SSI）是多节段后路器械固定融合治疗颈椎病性脊髓病（CSM）后发病率的一个重要来源。局部应用抗生素与后路器械固定融合术后 SSI 发生率降低有关，但尚无研究探讨这些措施对完全由后路颈椎多节段减压和器械固定治疗 CSM 的人群的影响。
纳入 2003 年至 2011 年间由同一位外科医生进行的多节段后路减压和 CSM 后路器械固定的所有患者。对前瞻性收集的数据进行事后分析，比较未使用万古霉素粉末治疗的连续患者与开始使用万古霉素粉末预防治疗的患者。对干预组和对照组进行 SSI 发生率、体重指数、神经状态、合并症和并发症的差异检查。
共有 112 例患者纳入本研究。干预组（n = 40）和对照组（n = 72）在年龄、体重指数、合并症、估计失血量和手术时间方面具有统计学相似性。单变量分析显示，在该高危人群中，干预组（0%）感染率显著低于对照组（15%）（P = 0.007；效能为 81%）。在使用万古霉素粉末的干预组中未发现与该药物相关的不良事件。
后路颈椎器械固定术中局部应用万古霉素可显著降低 CSM 后路多节段颈椎融合术后 SSI 的风险。本研究支持越来越多的证据表明，将万古霉素粉末置于伤口中可以降低术后伤口感染的发生率，而且这是第一个针对特定人群的研究。
2 级。
