垂直可扩展人工钛肋切口的伤口并发症
Wound complications of vertical expandable prosthetic titanium rib incisions.
作者信息
Garg Sumeet, LaGreca Jaren, St Hilaire Tricia, Gao Dexiang, Glotzbecker Michael, Li Ying, Smith John T, Flynn Jack
机构信息
*Children's Hospital Colorado, Aurora, CO; †University of Colorado, Denver, CO; ‡Chest Wall and Spine Deformity Research Foundation, Layton, UT; §Boston Children's Hospital, Boston, MA; ¶C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor, MI; ‖Primary Children's Medical Center, Salt Lake City, UT; and **The Children's Hospital of Philadelphia, Philadelphia, PA.
出版信息
Spine (Phila Pa 1976). 2014 Jun 1;39(13):E777-81. doi: 10.1097/BRS.0000000000000343.
STUDY DESIGN
Multicenter retrospective review.
OBJECTIVE
To compare the incidence of infection between vertical expandable prosthetic titanium rib (VEPTR) incision locations and determine if the infection risk increases in relation to presence of previous incisions and/or increased number of times incisions are opened.
SUMMARY OF BACKGROUND DATA
Patients undergoing treatment for chest and spine deformity with VEPTR require multiple incisions that are opened repeatedly during expansion procedures.
METHODS
A prospective database (7 sites) and institutional database (2 sites), were queried to identify their 20 most recent patients with VEPTR with a minimum of 4 expansions for inclusion. A total of 103 patients were identified. Clinical and operative reports were reviewed to determine incision locations, number, and infection complications.
RESULTS
Twenty-five of 103 patients (24%) developed an infection during treatment. Six had multiple infections (range, 2-4), providing a total of 34 infection events. Patients averaged 6.4 expansion procedures and 13 total incisions. Infection rate at each incision site was not significantly different, in the range from 1% to 5%: paramedian (6 infections/23 patients with total 185 incisions, 3%), proximal midline (12/39; 224, 5%), thoracotomy (6/61; 455, 1%), iliac (5/37; 143, 4%), and distal midline (5/58; 148, 3%). Infection events occurred after an average of 3 times a particular incision was opened (95% confidence interval: 2.2-3.8). There was a trend toward higher infection rate with increased number of times a particular incision was opened. There was no increased infection rate in patients with surgical incisions prior to VEPTR (26%; 6/23) compared with patients not having prior incisions (24%; 19/80).
CONCLUSION
The incidence of infection in patients with 4 or more VEPTR lengthenings was 24% and did not differ across the various incision locations. Presence of prior surgical incisions was not a risk factor for infection. Surgeons should use the most appropriate incision in relation to their patient's pathology when using VEPTR while remaining vigilant for infection.
LEVEL OF EVIDENCE
研究设计
多中心回顾性研究。
目的
比较垂直可扩张人工钛肋骨（VEPTR）切口部位的感染发生率，并确定感染风险是否会因既往切口的存在和/或切口打开次数的增加而升高。
背景数据总结
接受VEPTR治疗胸脊柱畸形的患者在扩张过程中需要多次切开并反复打开切口。
方法
查询前瞻性数据库（7个中心）和机构数据库（2个中心），以确定其20例最近接受VEPTR治疗且至少进行4次扩张的患者纳入研究。共识别出103例患者。回顾临床和手术报告以确定切口部位、数量和感染并发症。
结果
103例患者中有25例（24%）在治疗期间发生感染。6例发生多次感染（范围为2 - 4次），共发生34次感染事件。患者平均进行6.4次扩张手术，总共切开13次。各切口部位的感染率无显著差异，范围为1%至5%：旁正中切口（6例感染/23例患者，共185次切开，3%）、近端中线切口（12/39；224次切开，5%）、开胸切口（6/61；455次切开，1%）、髂骨切口（5/37；143次切开，4%）和远端中线切口（5/58；148次切开，3%）。感染事件平均发生在特定切口打开3次之后（95%置信区间：2.2 - 3.8）。特定切口打开次数增加时，感染率有升高趋势。与无既往手术切口的患者（24%；19/80）相比，VEPTR治疗前有手术切口的患者感染率未增加（26%；6/23）。
结论
接受4次或更多次VEPTR延长术的患者感染发生率为24%，各切口部位之间无差异。既往手术切口的存在不是感染的危险因素。使用VEPTR时，外科医生应根据患者病情选择最合适的切口，同时对感染保持警惕。
证据级别
3级
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