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负压伤口治疗可降低长节段胸腰椎脊柱融合术后伤口感染和裂开的发生率：单机构经验

Negative pressure wound therapy reduces incidence of postoperative wound infection and dehiscence after long-segment thoracolumbar spinal fusion: a single institutional experience.

作者信息

Adogwa Owoicho, Fatemi Parastou, Perez Edgar, Moreno Jessica, Gazcon Gustavo Chagoya, Gokaslan Ziya L, Cheng Joseph, Gottfried Oren, Bagley Carlos A

机构信息

Division of Neurosurgery, Duke University Medical Center, 3807, Durham, NC 27710, USA.

出版信息

Spine J. 2014 Dec 1;14(12):2911-7. doi: 10.1016/j.spinee.2014.04.011. Epub 2014 Apr 21.

DOI:10.1016/j.spinee.2014.04.011

PMID:24769401

Abstract

BACKGROUND CONTEXT

Wound dehiscence and surgical site infections (SSIs) can have a profound impact on patients as they often require hospital readmission, additional surgical interventions, lengthy intravenous antibiotic administration, and delayed rehabilitation. Negative pressure wound therapy (NPWT) exposes the wound site to negative pressure, resulting in the improvement of blood supply, removal of excess fluid, and stimulation of cellular proliferation of granulation tissue.

PURPOSE

To assess the incidence of wound infection and dehiscence in patients undergoing long-segment thoracolumbar fusion before and after the routine use of NPWT.

STUDY DESIGN

Retrospective study.

PATIENT SAMPLE

One hundred sixty patients undergoing long-segment thoracolumbar spine fusions were included in this study.

OUTCOME MEASURES

Postoperative incidence of wound infection and dehiscence.

METHODS

All adult patients undergoing thoracolumbar fusion for spinal deformity over a 6-year period at Duke University Medical Center by the senior author (CB) were included in this study. In 2012, a categorical change was made by the senior author (CB) that included the postoperative routine use of incisional NPWT devices after primary wound closure in all long-segment spine fusions. Before 2012, NPWT was not used. After primary wound closure, a negative pressure device is contoured to the size of the incision and placed over the incision site for 3 postoperative days. We retrospectively review the first 46 cases in which NPWT was used and compared them with the immediately preceding 114 cases to assess the incidence of wound infection and dehiscence.

RESULTS

One hundred sixty (NPWT: 46 cases, non-NPWT: 114 cases) long-segment thoracolumbar spine fusions were performed for deformity correction. Baseline characteristics were similar between both cohorts. Compared with the non-NPWT cohort, a 50% decrease in the incidence of wound dehiscence was observed in the NPWT patient cohort (6.38% vs. 12.28%, p=.02). Similarly, compared with the non-NPWT cohort, the incidence of postoperative SSIs was significantly decreased in the NPWT cohort (10.63% vs. 14.91%, p=.04).

CONCLUSIONS

Routine use of incisional NPWT was associated with a significant reduction in the incidence of postoperative wound infection and dehiscence.

摘要

背景

伤口裂开和手术部位感染（SSIs）会对患者产生深远影响，因为这些情况通常需要再次入院、额外的手术干预、长时间的静脉抗生素治疗以及延迟康复。负压伤口治疗（NPWT）使伤口部位暴露于负压下，从而改善血液供应、清除多余液体并刺激肉芽组织的细胞增殖。

目的

评估在常规使用NPWT前后，接受长节段胸腰椎融合手术患者的伤口感染和裂开发生率。

研究设计

回顾性研究。

患者样本

本研究纳入了160例接受长节段胸腰椎融合手术的患者。

观察指标

术后伤口感染和裂开的发生率。

方法

本研究纳入了在杜克大学医学中心由资深作者（CB）在6年期间为脊柱畸形接受胸腰椎融合手术的所有成年患者。2012年，资深作者（CB）做出了一项分类改变，即在所有长节段脊柱融合手术的初次伤口闭合后，术后常规使用切口NPWT装置。2012年之前，未使用NPWT。初次伤口闭合后，根据切口大小调整负压装置并放置在切口部位3天。我们回顾性分析了使用NPWT的前46例病例，并将其与之前的114例病例进行比较，以评估伤口感染和裂开的发生率。

结果

为矫正畸形进行了160例（NPWT组：46例，非NPWT组：114例）长节段胸腰椎融合手术。两组的基线特征相似。与非NPWT组相比，NPWT患者组的伤口裂开发生率降低了50%（6.38%对12.28%，p = 0.02）。同样，与非NPWT组相比，NPWT组的术后SSIs发生率显著降低（10.63%对14.91%，p = 0.04）。