Zwolak Pawel, König Matthias Alexander, Osterhoff Georg, Wilzeck Verena, Simmen Hans-Peter, Jukema Gerrolt Nico
Department of Trauma Surgery, University Hospital Zurich , Switzerland.
Orthop Rev (Pavia). 2013 Nov 6;5(4):e30. doi: 10.4081/or.2013.e30. eCollection 2013.
We present the results of the treatment of infected primary or delayed spine wounds after spinal surgery using negative pressure wound therapy. In our institution (University Hospital Zurich, Switzerland) nine patients (three women and six men; mean age 68.6, range 43-87 years) were treated in the period between January to December 2011 for non-healing spinal wounds. The treatment consisted of repeated debridements, irrigation and temporary closure with negative pressure wound therapy system. Three patients were admitted with a spinal epidural abscess; two with osteoporotic lumbar fracture; two with pathologic vertebra fracture and spinal cord compression, and two with vertebra fracture after trauma. All nine patients have been treated with antibiotic therapy. In one case the hardware has been removed, in three patients laminectomy was performed without instrumentation, in five patients there was no need to remove the hardware. The average hospital stay was 16.6 days (range 11-30). The average follow-up was 3.8, range 0.5-14 months. The average number of negative pressure wound therapy procedures was three, with the range 1-11. Our retrospective study focuses on the clinical problems faced by the spinal surgeon, clinical outcomes after spinal surgery followed by wound infection, and negative pressure wound therapy. Moreover, we would like to emphasize the importance for the patients and their relatives to be fully informed about the increased complications of surgery and about the limitations of treatment of these wounds with negative pressure wound therapy.
我们展示了使用负压伤口疗法治疗脊柱手术后原发性或延迟性感染性脊柱伤口的结果。在我们机构（瑞士苏黎世大学医院），2011年1月至12月期间，9名患者（3名女性和6名男性；平均年龄68.6岁，范围43 - 87岁）因脊柱伤口不愈合接受了治疗。治疗包括反复清创、冲洗以及使用负压伤口治疗系统进行临时封闭。3名患者因脊柱硬膜外脓肿入院；2名因骨质疏松性腰椎骨折；2名因病理性椎体骨折并伴有脊髓受压；2名因创伤后椎体骨折。所有9名患者均接受了抗生素治疗。1例患者取出了内固定装置，3例患者进行了无内固定的椎板切除术，5例患者无需取出内固定装置。平均住院时间为16.6天（范围11 - 30天）。平均随访时间为3.8个月，范围0.5 - 14个月。负压伤口治疗程序的平均次数为3次，范围为1 - 11次。我们的回顾性研究关注脊柱外科医生面临的临床问题、脊柱手术后伤口感染的临床结果以及负压伤口疗法。此外，我们想强调让患者及其亲属充分了解手术并发症增加以及负压伤口疗法治疗这些伤口的局限性的重要性。
