Issa Samir P, Angelliaume Audrey, Vidal Christophe, Mazda Keyvan, Ilharreborde Brice
Department of Pediatric Orthopaedic Surgery, Robert Debré Hospital, AP-HP, Paris Diderot University, Paris, France.
J Pediatr Orthop. 2017 Dec;37(8):e524-e529. doi: 10.1097/BPO.0000000000000736.
The incidence of surgical site infections (SSI) after adolescent idiopathic scoliosis (AIS) surgery ranges from 0.5% to 7%. There is currently a regain of interest in hybrid constructs, combining lumbar pedicle screws and thoracic sublaminar bands, but some authors have raised concerns about the risk of SSI and the difficulty of bacterial eradication. The goal of this study was therefore to assess the outcomes of SSI after AIS surgery using sublaminar bands.
A total of 524 consecutive patients operated for AIS using sublaminar bands between June 2006 and June 2014 were included. SSI cases were identified and analyzed retrospectively. Radiologic and functional outcomes were evaluated at follow-up using EOS imaging and SRS 30 scores, and compared with a control group.
The overall SSI rate was 5.3%, with a majority of monomicrobial (86%) infections occurring in the first 6 weeks postoperative (93%). The most frequent pathogens were skin germs (Staphylococcus aureus and Propionibacterium acnes) with a community profile. Patients were treated successfully with surgical debridement without implants removal, associated with 6 weeks of antibiotherapy. However, 25% of patients required >1 surgical debridement. Instrumentation removal was decided in the 2 cases with late SSI, and performed uneventfully. Radiologic and functional outcomes at follow-up were not affected by the occurrence of SSI.
Sublaminar bands are not associated with a higher risk of infection. However, the SSI rate in the current study stands in the upper range of the literature, and other preventive strategies should be considered. In case of early infection, bands removal is not necessary to obtain pathogen eradication, but the sublaminar implants can be pulled out safely in case of late SSI. The occurrence of SSI does not alter the outcomes at follow-up.
Level III.
青少年特发性脊柱侧凸（AIS）手术后手术部位感染（SSI）的发生率在0.5%至7%之间。目前，人们对结合腰椎椎弓根螺钉和胸椎椎板下带的混合结构重新产生了兴趣，但一些作者对SSI的风险以及细菌根除的难度表示担忧。因此，本研究的目的是评估使用椎板下带进行AIS手术后SSI的结果。
纳入了2006年6月至2014年6月期间共524例连续使用椎板下带进行AIS手术的患者。对SSI病例进行回顾性识别和分析。随访时使用EOS成像和SRS 30评分评估放射学和功能结果，并与对照组进行比较。
总体SSI发生率为5.3%，大多数单一微生物感染（86%）发生在术后前6周（93%）。最常见的病原体是具有社区特征的皮肤细菌（金黄色葡萄球菌和痤疮丙酸杆菌）。患者通过手术清创成功治疗，无需取出植入物，并联合6周的抗生素治疗。然而，25%的患者需要进行>1次手术清创。在2例迟发性SSI病例中决定取出内固定器械，手术过程顺利。随访时的放射学和功能结果不受SSI发生的影响。
椎板下带与较高的感染风险无关。然而，本研究中的SSI发生率处于文献报道的较高范围，应考虑其他预防策略。在早期感染的情况下，无需取出椎板下带即可根除病原体，但在迟发性SSI的情况下，可以安全地取出椎板下植入物。SSI的发生不会改变随访结果。
III级。
