Janssen Daniël M C, Kramer Maud, Geurts Jan, Rhijn Lodewijk V, Walenkamp Geert H I M, Willems Paul C
Department of Orthopaedic Surgery, Research School CAPHRI, Maastricht University Medical Center, Maastricht, the Netherlands.
J Bone Jt Infect. 2018 May 21;3(2):94-103. doi: 10.7150/jbji.23832. eCollection 2018.
There is no generally established treatment algorithm for the management of surgical site infection (SSI) and non-union after instrumented spinal surgery. In contrast to infected hip- and knee- arthroplasties, the use of a local gentamicin impregnated carrier in spinal surgery has not been widely reported in literature. We studied 48 deep SSI and non-union patients after instrumented spine surgery, treated between 1999 and 2016. The minimum follow-up was 1.5 years. All infections were treated with a treatment-regimen consisting of systemic antibiotics and repetitive surgical debridement, supplemented with local gentamicin releasing carriers. We analysed the outcome of this treatment regimen with regard to healing of the infection, as well as patient- and surgery-characteristics of failed and successfully treated patients. 42 of the 48 (87.5%) patients showed successful resolution of the SSI without recurrence with a stable spine at the end of treatment. 36 patients' SSI were treated with debridement, local antibiotics, and retention or eventual restabilization of the instrumentation in case of loosening. 3 patients were treated without local antibiotics because of very mild infection signs during the revision operation. 3 patients were treated with debridement, local antibiotics and removal of instrumentation. One of these patients was restabilized in a second procedure. Infection persisted or recurred in 6 patients. These patients had a worse physical status with a higher ASA-score. was the most frequent causative microorganism. Debridement and retention of the instrumentation, in combination with systemic antibiotics and the addition of local antibiotics provided a successful treatment for SSI and non-union after instrumented spinal fusion.
对于脊柱内固定手术后手术部位感染（SSI）和骨不连的处理，目前尚无普遍确立的治疗方案。与感染的髋关节和膝关节置换术不同，脊柱手术中使用局部庆大霉素浸渍载体在文献中尚未得到广泛报道。我们研究了1999年至2016年间接受脊柱内固定手术后发生48例深部SSI和骨不连的患者。最短随访时间为1.5年。所有感染均采用由全身抗生素和重复手术清创组成的治疗方案，并辅以局部释放庆大霉素的载体进行治疗。我们分析了该治疗方案在感染愈合方面的结果，以及治疗失败和成功患者的患者及手术特征。48例患者中有42例（87.5%）在治疗结束时SSI成功消退且无复发，脊柱稳定。36例患者的SSI采用清创、局部使用抗生素以及在器械松动时保留或最终重新稳定器械的方法进行治疗。3例患者因翻修手术期间感染迹象非常轻微未使用局部抗生素。3例患者采用清创、局部使用抗生素并取出器械的方法进行治疗。其中1例患者在第二次手术中重新获得稳定。6例患者感染持续或复发。这些患者身体状况较差，ASA评分较高。 是最常见的致病微生物。清创和保留器械，结合全身抗生素并添加局部抗生素，为脊柱内固定融合术后的SSI和骨不连提供了成功的治疗方法。
