小儿颈椎手术后的深部手术部位感染

Deep Surgical Site Infections Following Pediatric Cervical Spine Surgery.

作者信息

Porter David A, Glotzbecker Michael P, Timothy Hresko M, Hedequist Daniel J

机构信息

*Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY †Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.

出版信息

J Pediatr Orthop. 2017 Dec;37(8):553-556. doi: 10.1097/BPO.0000000000000813.

DOI:10.1097/BPO.0000000000000813

PMID:27280897

Abstract

OF BACKGROUND DATA

This is the first reported series looking specifically at factors associated with deep surgical site infections (SSI) following pediatric cervical spine surgery.

OBJECTIVE

To identify risk factors present in pediatric patients who are at risk for SSI following cervical spine surgery.

DESIGN

Level of evidence: level IV-retrospective case series.

INTRODUCTION

To date there are no studies regarding SSI in pediatric cervical spine surgery and thus no benchmark data or risk factors have been identified.

METHODS

Patients with acute deep SSIs occurring within 90 days of the index operation were identified. Patient and surgical characteristics were analyzed for possible predictors of SSI outcome using penalized likelihood logistic regression analysis. Characteristics analyzed included: age, diagnosis, comorbidity, levels fused, approach, implants used, allograft, halo, body mass index, revision, antibiotic dosing, and occipital plating.

RESULTS

A total of 112 patients were included in the study at a mean age of 12.5 years (2 to 18 y). Comorbidities were present in 51 (46%) patients, 15 patients had a documented connective tissue disorder (CTD). The mean number of levels fused was 3.7 (2 to 7) and mean number of screws was 4.4 (2 to 11). Allograft was used alone in 48 patients, occipital plating in 28 patients, and a halo in 39 patients. Deep SSI occurred in 3 patients: two of which had a CTD (1 Trisomy 21, 1 Ehlers-Danlos) and 1 patient with postradiation cervical kyphosis. All were gram-positive infections requiring return to operating room with prolonged IV antibiotics. All patients recovered and fused with spinal implant retention. The incidence of deep SSI was 2.7%. It was determined that a CTD was the only significant predictor of SSI. Subjects with a CTD had 12 times the odds of SSI [odds ratio=12 (1.5, 137.0); P=0.02].

CONCLUSIONS

In our series of pediatric patients the incidence of a deep SSI was 2.7%. The only predictor of SSI was the presence of a CTD.

摘要

背景数据

这是首个专门研究小儿颈椎手术后深部手术部位感染（SSI）相关因素的系列报道。

目的

确定颈椎手术后有发生SSI风险的小儿患者存在的危险因素。

设计

证据级别：IV级——回顾性病例系列。

引言

迄今为止，尚无关于小儿颈椎手术中SSI的研究，因此尚未确定基准数据或危险因素。

方法

确定在初次手术后90天内发生急性深部SSI的患者。使用惩罚似然逻辑回归分析，分析患者和手术特征，以寻找SSI结局的可能预测因素。分析的特征包括：年龄、诊断、合并症、融合节段、手术入路、使用的植入物、同种异体移植物、头环、体重指数、翻修手术、抗生素剂量和枕部钢板固定。

结果

共有112例患者纳入本研究，平均年龄12.5岁（2至18岁）。51例（46%）患者存在合并症，15例患者有记录在案的结缔组织病（CTD）。平均融合节段数为3.7（2至7个），平均螺钉数为4.4（2至11枚）。48例患者单独使用同种异体移植物，28例患者使用枕部钢板固定，39例患者使用头环。3例患者发生深部SSI：其中2例患有CTD（1例21三体综合征，1例埃勒斯-当洛综合征），1例患有放疗后颈椎后凸畸形。所有感染均为革兰氏阳性菌感染，需要返回手术室并延长静脉使用抗生素时间。所有患者均康复，脊柱植入物保留且实现融合。深部SSI的发生率为2.7%。确定CTD是SSI的唯一显著预测因素。患有CTD的受试者发生SSI的几率是其他受试者的12倍[比值比=12（1.5，137.0）；P=0.02]。