脊柱内固定手术后迟发性深部手术部位感染的处理
Management of late-onset deep surgical site infection after instrumented spinal surgery.
作者信息
Yin Dong, Liu Bin, Chang Yunbing, Gu Honglin, Zheng Xiaoqing
机构信息
Department of Orthopaedics, Guangdong General Hospital, Guangdong Academy of Medical Sciences, P. O. Box 510080, No.106 Zhongshan Er Road, Yuexiu District, Guangzhou, China.
出版信息
BMC Surg. 2018 Dec 22;18(1):121. doi: 10.1186/s12893-018-0458-4.
BACKGROUND
There are no universally accepted protocols for the treatment of late-onset deep surgical site infection. This study retrospectively evaluates the methods of aggressive debridement with instrumentation retention, high vacuum closed-suction drain without irrigation, primary wound closure, and antibiotic therapy for the treatment of late-onset deep surgical site infection after instrumented spinal surgery.
METHODS
A total of 4057 patients who underwent instrumented spinal surgeries were surveyed from January 2010 to June 2014. Surgical debridement was performed immediately after late-onset deep surgical site infection was identified. In addition to extended resection of the devitalized and necrotic tissue, the biofilms adhered to the surface of implants were removed meticulously and thoroughly. Primary wound closure was performed on each patient, and closed suction drains were maintained for about 7-10 days without irrigation. Antibiotic therapy was administered for 3 months according to the results of the pathogenic culture.
RESULTS
Forty-two patients were identified as having late-onset deep surgical site infection. Staphylococcus aureus was the most common pathogen in this group. Seven patients with late-onset deep surgical site infection had negative bacterial culture results. Infections resolved in all patients. Forty-one patients retained their instrumentation, whereas 1 patient had the implants removed because of Staphylococcus aureus infection, which was found the implants loosening during debridement. Primary wound healing was found in all patients with no recurrence of infection during the follow-up periods.
CONCLUSIONS
A timely diagnosis, aggressive and meticulous debridement, high vacuum closed-suction drain, routine and adequate use of antibacterial agents are the keys to successfully resolving infection and keeping implants retention in the treatment of late-onset deep surgical site infection after instrumented spinal surgery.
背景
对于迟发性深部手术部位感染的治疗，目前尚无普遍接受的方案。本研究回顾性评估了保留内固定器械的积极清创、不冲洗的高负压封闭吸引引流、一期伤口缝合以及抗生素治疗等方法，用于治疗脊柱内固定手术后迟发性深部手术部位感染。
方法
对2010年1月至2014年6月期间接受脊柱内固定手术的4057例患者进行了调查。在确诊迟发性深部手术部位感染后立即进行手术清创。除广泛切除失活和坏死组织外，还需仔细彻底清除附着于植入物表面的生物膜。对每位患者进行一期伤口缝合，并维持封闭吸引引流约7 - 10天，不进行冲洗。根据病原菌培养结果给予3个月的抗生素治疗。
结果
42例患者被确诊为迟发性深部手术部位感染。金黄色葡萄球菌是该组中最常见的病原体。7例迟发性深部手术部位感染患者细菌培养结果为阴性。所有患者感染均得到解决。41例患者保留了内固定器械，而1例患者因金黄色葡萄球菌感染在清创时发现植入物松动，故将植入物取出。所有患者伤口均一期愈合，随访期间无感染复发。
结论
及时诊断、积极细致的清创、高负压封闭吸引引流、常规且充分使用抗菌药物是成功解决脊柱内固定手术后迟发性深部手术部位感染并保留植入物的关键。
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