手术部位感染是成人脊柱畸形手术中假关节形成的主要危险因素。
Surgical site infection is a major risk factor of pseudarthrosis in adult spinal deformity surgery.
机构信息
Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.
Université de Bordeaux, Bordeaux University Hospital, Department of Spinal Surgery Unit 1, C.H.U Tripode Pellegrin, Place Amélie Raba Léon, 33076 Bordeaux, France.
出版信息
Spine J. 2022 Dec;22(12):2059-2065. doi: 10.1016/j.spinee.2022.08.022. Epub 2022 Sep 6.
BACKGROUND CONTEXT
Despite the evidence in appendicular skeletal surgery, the effect of infection on spinal fusion remains unclear, particularly after Adult Spinal Deformity (ASD) surgery.
PURPOSE
The purpose of this study was to determine the impact of surgical site infection (SSI) in ASD surgery fusion rates and its association with other risks factors of pseudarthrosis.
STUDY DESIGN
We conducted an international multicenter retrospective study on a prospective cohort of patients operated for spinal deformity.
PATIENT SAMPLE
A total of 956 patients were included (762 females and 194 males).
OUTCOME MEASURES
Patient's preoperative characteristics, pre and postoperative spinopelvic parameters, surgical variables, postoperative complications and were recorded. Surgical site infections were asserted in case of clinical signs associated with positive surgical samples. Each case was treated with surgical reintervention for debridement and irrigation. Presence of pseudarthrosis was defined by the association of clinical symptoms and radiological signs of nonfusion (either direct evidence on CT-scan or indirect radiographic clues such as screw loosening, rod breakage, screw pull out or loss of correction). Each iterative surgical intervention was collected.
METHODS
Univariate and multivariate analysis with logistic regression models were performed to evaluate the role of risk factors of pseudarthrosis.
RESULTS
Nine hundred fifty-six surgical ASD patients with more than two years of follow-up were included in the study. 65 of these patients were treated for SSI (6.8%), 138 for pseudarthrosis (14.4%), and 28 patients for both SSI and pseudarthrosis. On multivariate analysis, SSI was found to be a major risk factor of pseudarthrosis (OR=4.4; 95% CI=2.4,7.9) as well as other known risks factors: BMI (OR=1.1; 95% CI=1.0,1.1), smoking (OR=1.6; 95% CI=1.1,2.9), performance of Smith-Petersen osteotomy (OR = 1.6; 95% CI 1.0,2.6), number of vertebrae instrumented (OR=1.1; 95% CI=1.1,1.2) and the caudal level of fusion, with a distal exponential increment of the risk (OR max for S1=6, 95% CI=1.9,18.6).
CONCLUSION
SSI significantly increases the risk of pseudarthrosis with an OR of 4.4.
背景
尽管在附肢骨骼手术中有证据表明，但感染对脊柱融合的影响仍不清楚，尤其是在成人脊柱畸形（ASD）手术后。
目的
本研究旨在确定脊柱融合术后手术部位感染（SSI）对融合率的影响，并确定其与假关节形成其他危险因素的关系。
研究设计
我们对接受脊柱畸形手术的前瞻性队列患者进行了国际多中心回顾性研究。
患者样本
共纳入 956 例患者（762 例女性和 194 例男性）。
观察指标
记录患者术前特征、术前和术后脊柱骨盆参数、手术变量、术后并发症等。如果出现与阳性手术样本相关的临床体征，则确定为手术部位感染。每个病例均通过清创和灌洗进行手术再干预。假关节的存在定义为临床症状与非融合的影像学表现（CT 扫描的直接证据或螺钉松动、棒断裂、螺钉拔出或矫正丢失等间接影像学线索）相关。
方法
采用单变量和多变量逻辑回归模型进行分析，以评估假关节形成的危险因素的作用。
结果
共纳入 956 例接受 ASD 手术且随访时间超过 2 年的患者。其中 65 例患者接受了 SSI 治疗（6.8%），138 例患者接受了假关节治疗（14.4%），28 例患者同时接受了 SSI 和假关节治疗。多变量分析显示，SSI 是假关节形成的主要危险因素（OR=4.4；95%CI=2.4,7.9），以及其他已知的危险因素：BMI（OR=1.1；95%CI=1.0,1.1）、吸烟（OR=1.6；95%CI=1.1,2.9）、行 Smith-Petersen 截骨术（OR=1.6；95%CI=1.0,2.6）、器械固定的椎体数量（OR=1.1；95%CI=1.1,1.2）和融合的尾端水平，风险呈远端指数递增（OR max 对于 S1=6，95%CI=1.9,18.6）。
结论
SSI 显著增加了假关节形成的风险，OR 为 4.4。
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