St. Franziskus Hospital and Universitat Autònoma de Barcelona, Spine Surgery, Schönsteinstr 63, Cologne, Germany.
Bone Joint J. 2013 Aug;95-B(8):1121-6. doi: 10.1302/0301-620X.95B8.30784.
This study evaluates the long-term survival of spinal implants after surgical site infection (SSI) and the risk factors associated with treatment failure. A Kaplan-Meier survival analysis was carried out on 43 patients who had undergone a posterior spinal fusion with instrumentation between January 2006 and December 2008, and who consecutively developed an acute deep surgical site infection. All were appropriately treated by surgical debridement with a tailored antibiotic program based on culture results for a minimum of eight weeks. A 'terminal event' or failure of treatment was defined as implant removal or death related to the SSI. The mean follow-up was 26 months (1.03 to 50.9). A total of ten patients (23.3%) had a terminal event. The rate of survival after the first debridement was 90.7% (95% confidence interval (CI) 82.95 to 98.24) at six months, 85.4% (95% CI 74.64 to 96.18) at one year, and 73.2% (95% CI 58.70 to 87.78) at two, three and four years. Four of nine patients required re-instrumentation after implant removal, and two of the four had a recurrent infection at the surgical site. There was one recurrence after implant removal without re-instrumentation. Multivariate analysis revealed a significant risk of treatment failure in patients who developed sepsis (hazard ratio (HR) 12.5 (95% confidence interval (CI) 2.6 to 59.9); p < 0.001) or who had > three fused segments (HR 4.5 (95% CI 1.25 to 24.05); p = 0.03). Implant survival is seriously compromised even after properly treated surgical site infection, but progressively decreases over the first 24 months.
本研究评估了脊柱植入物在手术部位感染（SSI）后的长期存活率以及与治疗失败相关的危险因素。对 2006 年 1 月至 2008 年 12 月间接受后路脊柱融合内固定术且随后发生急性深部手术部位感染的 43 例患者进行了 Kaplan-Meier 生存分析。所有患者均通过手术清创和基于培养结果的个体化抗生素方案（至少 8 周）得到适当治疗。将植入物移除或与 SSI 相关的死亡定义为“终末事件”或治疗失败。平均随访时间为 26 个月（1.03-50.9）。共有 10 例患者（23.3%）发生终末事件。第一次清创后，生存率为 6 个月时 90.7%（95%置信区间（CI）82.95-98.24），1 年时 85.4%（95% CI 74.64-96.18），2、3、4 年时分别为 73.2%（95% CI 58.70-87.78）。9 例患者中有 4 例在植入物移除后需要重新内固定，其中 4 例中有 2 例在手术部位再次发生感染。有 1 例在移除植入物后没有重新内固定的情况下出现了复发。多变量分析显示，发生脓毒症的患者（风险比（HR）12.5（95%置信区间（CI）2.6-59.9）；p<0.001）或融合节段>3 个的患者（HR 4.5（95% CI 1.25-24.05）；p=0.03）的治疗失败风险显著增加。即使经过适当治疗的手术部位感染，植入物的存活率仍严重受损，但在前 24 个月内逐渐下降。
