Ando Muneharu, Tamaki Tetsuya, Yoshida Munehito, Sasaki Shunji, Toge Yasushi, Matsumoto Takuji, Maio Kazuhiro, Sakata Ryosuke, Fukui Daisuke, Kanno Seiji, Nakagawa Yukihiro, Yamada Hiroshi
Department of Orthopedic Surgery, Wakayama Rosai Hospital, 93-1 Kinomoto, Wakayama, Wakayama, 640-8505, Japan,
Eur Spine J. 2014 Apr;23(4):854-62. doi: 10.1007/s00586-014-3202-5. Epub 2014 Feb 1.
Surgical site infection (SSI) after spinal surgery is a devastating complication. Various methods of skin closure are used in spinal surgery, but the optimal skin-closure method remains unclear. A recent report recommended against the use of metal staples for skin closure in orthopedic surgery. 2-Octyl-cyanoacrylate (Dermabond; Ethicon, NJ, USA) has been widely applied for wound closure in various surgeries. In this cohort study, we assessed the rate of SSI in spinal surgery using metal staples and 2-octyl-cyanoacrylate for wound closure.
This study enrolled 609 consecutive patients undergoing spinal surgery in our hospital. From April 2007 to March 2010 surgical wounds were closed with metal staples (group 1, n = 294). From April 2010 to February 2012 skin closure was performed using 2-octyl-cyanoacrylate (group 2, n = 315). We assessed the rate of SSI using these two different methods of wound closure. Prospective study of the time and cost evaluation of wound closure was performed between two groups.
Patients in the 2-octyl-cyanoacrylate group had more risk factors for SSI than those in the metal-staple group. Nonetheless, eight patients in the metal-staple group compared with none in the 2-octyl-cyanoacrylate group acquired SSIs (p < 0.01). The closure of the wound in length of 10 cm with 2-octyl-cyanoacrylate could save 28 s and $13.5.
This study reveals that in spinal surgery, wound closure using 2-octyl-cyanoacrylate was associated with a lower rate of SSI than wound closure with staples. Moreover, the use of 2-octyl-cyanoacrylate has a more time saving effect and cost-effectiveness than the use of staples in wound closure of 10 cm in length.
脊柱手术后手术部位感染（SSI）是一种严重的并发症。脊柱手术中使用了多种皮肤缝合方法，但最佳的皮肤缝合方法仍不明确。最近一份报告建议在骨科手术中不要使用金属钉进行皮肤缝合。2-辛基氰基丙烯酸酯（皮肤粘合剂；美国新泽西州Ethicon公司）已广泛应用于各种手术的伤口闭合。在这项队列研究中，我们评估了在脊柱手术中使用金属钉和2-辛基氰基丙烯酸酯进行伤口闭合时的SSI发生率。
本研究纳入了我院连续609例行脊柱手术的患者。2007年4月至2010年3月，手术伤口用金属钉闭合（第1组，n = 294）。2010年4月至2012年2月，使用2-辛基氰基丙烯酸酯进行皮肤闭合（第2组，n = 315）。我们评估了使用这两种不同伤口闭合方法时的SSI发生率。对两组之间伤口闭合的时间和成本评估进行了前瞻性研究。
2-辛基氰基丙烯酸酯组患者发生SSI的危险因素比金属钉组更多。尽管如此，金属钉组有8例患者发生了SSI，而2-辛基氰基丙烯酸酯组无一例发生（p < 0.01）。用2-辛基氰基丙烯酸酯闭合10 cm长的伤口可节省28秒和13.5美元。
本研究表明，在脊柱手术中，使用2-辛基氰基丙烯酸酯闭合伤口的SSI发生率低于使用金属钉闭合伤口。此外，在长度为10 cm的伤口闭合中，使用2-辛基氰基丙烯酸酯比使用金属钉更节省时间且具有成本效益。
