Dobran Mauro, Mancini Fabrizio, Nasi Davide, Scerrati Massimo
Department of Neurosurgery, Umberto I General Hospital, Ancona, italy, Italy.
BMJ Case Rep. 2017 Jul 28;2017:bcr-2017-220792. doi: 10.1136/bcr-2017-220792.
Until today the role of spinal instrumentation in the presence of a wound infection has been widely discussed and recently many authors leave the hardware in place with appropriate antibiotic therapy. This is a case of a 65-year-old woman suffering from degenerative scoliosis and osteoporotic multiple vertebral collapses treated with posterior dorsolumbar stabilisation with screws and rods. Four months later, skin necrosis and infection appeared in the cranial wound with exposure of the rods. A surgical procedure of debridement of the infected tissue and package with a myocutaneous trapezius muscle flap was performed. One week after surgery, negative pressure wound therapy was started on the residual skin defect. The wound healed after 2 months. The aim of this case report is to focus on the utility of this method even in the case of hardware exposure and infection. This may help avoid removing instrumentation and creating instability.
直到今天，脊柱内固定装置在伤口感染情况下的作用一直被广泛讨论，最近许多作者主张在进行适当抗生素治疗的同时保留内固定装置。本文报道了一例65岁女性患者，患有退行性脊柱侧弯和骨质疏松性多发椎体塌陷，接受了后路腰椎螺钉棒内固定术。四个月后，头部伤口出现皮肤坏死和感染，内固定棒外露。进行了感染组织清创术并用斜方肌肌皮瓣包裹。术后一周，对残留皮肤缺损开始进行负压伤口治疗。伤口在2个月后愈合。本病例报告的目的是强调即使在内固定装置外露和感染的情况下这种方法的实用性。这可能有助于避免移除内固定装置并造成不稳定。
