Sawires Andrew N, Park Paul J, Lenke Lawrence G
Lenox Hill Hospital, Department of Orthopaedic Surgery, New York, NY, USA.
Columbia University Irving Medical Center, Department of Orthopedic Surgery, New York, NY, USA.
J Spine Surg. 2021 Sep;7(3):413-421. doi: 10.21037/jss-21-10.
Spinal infections associated with pediatric and adult spinal deformity surgery are associated with postoperative morbidity and mortality along with elevated health-care costs. Prevention requires meticulous technique by the spine surgeon throughout the perioperative period. There is significant variability in the current practices of spinal deformity surgeons with regard to infection prevention, stemming from the lack of reliable evidence available in the literature. There has also been a lack of literature detailing the difference in infection rates and risk factors between pediatric and adult patients undergoing deformity correction surgery. In this narrative review we looked at 60 studies in the adult population and 9 studies in the pediatric population. Most of these studies of surgical site infections (SSI) in spinal deformity surgery have been performed in adult patients, however it is clear that the pediatric neuromuscular patient requires particular attention that we discuss in detail. This narrative review of the literature outlines evidence and compares and contrasts data for preventive strategies and modifiable risk factors to decrease rates of SSI in the pediatric and adult spinal deformity patient populations. In this review we discuss techniques relating to preoperative cleansing protocols, antibiotic administration, gentle soft tissue handling, appropriate closure, drain usage, and intraoperative technique itself to minimize EBL and operative time.
与小儿及成人脊柱畸形手术相关的脊柱感染会导致术后发病和死亡，并增加医疗成本。预防需要脊柱外科医生在围手术期全程采用细致的技术。由于文献中缺乏可靠证据，脊柱畸形外科医生目前在感染预防方面的做法存在很大差异。也缺乏文献详细说明接受畸形矫正手术的小儿和成人患者在感染率和危险因素方面的差异。在这篇叙述性综述中，我们查阅了60项针对成人的研究和9项针对小儿的研究。脊柱畸形手术中大多数关于手术部位感染（SSI）的研究都是在成年患者中进行的，然而很明显，小儿神经肌肉疾病患者需要特别关注，我们将对此进行详细讨论。这篇文献叙述性综述概述了相关证据，并比较和对比了预防策略及可改变的危险因素的数据，以降低小儿和成人脊柱畸形患者群体的SSI发生率。在这篇综述中，我们讨论了与术前清洁方案、抗生素使用、轻柔的软组织处理、适当的缝合、引流管使用以及手术技术本身相关的技术，以尽量减少术中出血量（EBL）和手术时间。
