Gómez Cáceres A, Lucena Jiménez J S, Reyes Martín Á L, Moriel Durán J, Sobrino Diaz B, García de Quevedo Puerta D
Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
Departamento de Cirugía Ortopédica y Traumatología, Hospital Regional Universitario de Málaga, Málaga, España.
Rev Esp Cir Ortop Traumatol (Engl Ed). 2019 Jan-Feb;63(1):7-11. doi: 10.1016/j.recot.2018.10.001. Epub 2018 Dec 7.
Surgical site infections (SSIs) are complications that predispose to a high risk of unfavourable surgical outcomes. The aim of this study was to assess the SSI rate in this type of patients and their prognosis with similar treatment.
A retrospective case series of 799 patients above 18 years old with spinal instrumentation surgery, between January 2010 and December 2014 in the traumatology and orthopaedic surgery department of our institution. All patients with SSIs were treated by debridement, graft replacement, retention of the instrumentation and lengthy courses of antimicrobial therapy. The patients were followed up for a period of 12 months.
Of all the patients with arthrodesis, 32 (4%) had spinal SSIs. Three patients were lost to follow-up. The final sample analyzed comprised 29 cases, with a median age of 54.9 years (IQR, 45.7-67 years) and a Charlson comorbidity index of 2.0 (IQR; 0-3). A microbiological diagnosis was obtained in 75.8% of the cases. Of these, the ISSs were monomicrobial in 68.2% and polymicrobial in 31.8%. Once treatment had been completed, 96% were cured without sequelae, and the rate of recurrence and reoperation was 4%.
Treatment based on debridement, retention of the instrumentation, graft replacement and lengthy courses of antimicrobial therapy seems a very effective strategy in the treatment of patients with deep surgical site infection in spine surgery.
手术部位感染（SSIs）是一种并发症，易导致不良手术结局的高风险。本研究的目的是评估这类患者的手术部位感染率及其采用相似治疗方法的预后情况。
对2010年1月至2014年12月期间在我院创伤与骨科手术科室接受脊柱内固定手术的799例18岁以上患者进行回顾性病例系列研究。所有手术部位感染患者均接受清创、植骨置换、内固定保留及长时间抗菌治疗。对患者进行了为期12个月的随访。
在所有接受关节融合术的患者中，32例（4%）发生脊柱手术部位感染。3例患者失访。最终分析的样本包括29例，中位年龄为54.9岁（四分位间距，45.7 - 67岁），Charlson合并症指数为2.0（四分位间距；0 - 3）。75.8%的病例获得了微生物学诊断。其中，手术部位感染为单一微生物感染的占68.2%，多微生物感染的占31.8%。治疗完成后，96%的患者治愈且无后遗症，复发率和再次手术率为4%。
基于清创、保留内固定、植骨置换及长时间抗菌治疗的方法似乎是治疗脊柱手术深部手术部位感染患者的一种非常有效的策略。
