Department of Paediatric Orthopaedic Surgery, Turku University Central Hospital, Turku, Finland.
Scand J Surg. 2014 Mar;103(1):60-5. doi: 10.1177/1457496913504910. Epub 2014 Feb 11.
Surgical site infections are relatively common after spinal deformity surgery. Early detection of deep wound infections is important, since it may allow retention of spinal instrumentation. However, serum C-reactive protein and erythrocyte sedimentation rate may remain elevated for almost 6 weeks, making differential diagnosis of systemic inflammatory response and acute deep bacterial wound infection difficult. Plasma procalcitonin has been suggested to be a useful indicator for bacterial infection. However, there are no studies evaluating behavior of procalcitonin in patients undergoing major spine surgery with instrumentation.
A total of 50 consecutive adolescents (37 idiopathic scoliosis and 13 neuromuscular scoliosis, mean age = 15 years at surgery and follow-up time = 21 months (range = 12-29 months)) undergoing scoliosis surgery participated in this prospective follow-up study. White blood cell count, serum C-reactive protein, and plasma procalcitonin levels were measured on the day before surgery, on the day of surgery, and daily thereafter for 1 week. None of the patients developed signs of acute or delayed wound infection during the follow-up period; however, two neuromuscular scoliosis patients developed severe postoperative pneumonia, and their inflammatory parameter data will be reported separately.
Plasma procalcitonin levels peaked on the first postoperative day (mean = 0.19 ng/mL, range = 0.04-1.29 ng/mL), and mean values were less than 0.5 ng/mL during the whole first postoperative week, while C-reactive protein remained elevated during the whole first postoperative week (highest mean value = 63.8 mg/L (range = 5-248 mg/L) on third postoperative day). Patients with idiopathic scoliosis had lower C-reactive protein levels (p < 0.05 from first to sixth postoperative day) and lower procalcitonin levels (p < 0.05 from third to seventh postoperative day) than neuromuscular scoliosis patients. Two patients with postoperative pneumonia showed elevated procalcitonin values over the whole postoperative week (22.34 ng/mL and 0.72 ng/mL highest values, respectively).
Elevated plasma procalcitonin levels seem useful when excluding acute deep wound infection from systemic inflammatory response.
脊柱畸形手术后，手术部位感染较为常见。早期发现深部伤口感染非常重要，因为这可能允许保留脊柱内固定物。然而，血清 C 反应蛋白和红细胞沉降率可能在近 6 周内持续升高，使得全身炎症反应和急性深部细菌性伤口感染的鉴别诊断变得困难。降钙素原已被认为是细菌感染的有用指标。然而，目前尚无研究评估降钙素原在接受重大脊柱手术和内置物的患者中的行为。
共有 50 名连续的青少年（37 名特发性脊柱侧凸和 13 名神经肌肉性脊柱侧凸，手术时平均年龄为 15 岁，随访时间为 21 个月（范围为 12-29 个月））接受脊柱侧凸手术参与了这项前瞻性随访研究。在手术前一天、手术当天以及此后每天测量白细胞计数、血清 C 反应蛋白和血浆降钙素原水平，持续 1 周。在随访期间，没有患者出现急性或迟发性伤口感染的迹象；然而，两名神经肌肉性脊柱侧凸患者发生严重的术后肺炎，他们的炎症参数数据将分别报告。
降钙素原水平在术后第一天达到峰值（平均值=0.19ng/mL，范围=0.04-1.29ng/mL），整个术后第一周均值均小于 0.5ng/mL，而 C 反应蛋白在整个术后第一周仍处于升高状态（术后第 3 天最高均值=63.8mg/L（范围=5-248mg/L））。特发性脊柱侧凸患者的 C 反应蛋白水平较低（第 1 至第 6 天低于神经肌肉性脊柱侧凸患者，p<0.05），降钙素原水平也较低（第 3 至第 7 天低于神经肌肉性脊柱侧凸患者，p<0.05）。两名术后肺炎患者整个术后周的降钙素原值均升高（最高值分别为 22.34ng/mL 和 0.72ng/mL）。
当排除全身炎症反应中的急性深部伤口感染时，升高的血浆降钙素原水平似乎有用。
