Mengis-Palleck Charles Louis, Tomé-Bermejo Félix, Piñera-Parrilla Ángel, Cervera-Irimia Javier, Gallego-Bustos Jesús, Garzón-Márquez Francisco, Rodríguez-Arguisjuela María G, Sanz-Aguilera Sylvia, Peiro-Garcia Alejandro, Álvarez-Galovich Luis
Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid.
Spine Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, Spain, Madrid
Int J Spine Surg. 2023 Aug;17(4):587-597. doi: 10.14444/8474. Epub 2023 May 22.
Retrospective observational study of prospectively collected outcomes.
The use of transpedicular screws augmented with polymethyl methacrylate (PMMA) is an alternative for patients with osteoporotic vertebrae. To investigate whether using PMMA-augmented screws in patients undergoing elective instrumented spinal fusion (ISF) is correlated with an increased risk of infection and the long-term survival of these spinal implants after surgical site infection (SSI).
We studied 537 consecutive patients who underwent ISF at some point within a 9-year period, involving a total of 2930 PMMA-augmented screws. Patients were classified into groups: (1) those whose infection was cured with irrigation, surgical debridement, and antibiotic treatment; (2) those whose infection was cured by hardware removal or replacement; and (3) those in whom treatment failed.
Twenty eight of the 537 patients (5.2%) developed SSI after ISF. An SSI developed after primary surgery in 19 patients (4.6%) and after revision surgery in 9 (7.25%). Eleven patients (39.3%) were infected with gram-positive bacteria, 7 (25%) with gram-negative bacteria, and 10 (35.7%) with multiple pathogens. By 2 years after surgery, infection had been cured in 23 patients (82.15%). Although there were no statistically significant differences in infection incidence between preoperative diagnoses ( = 0.178), the need to remove hardware for infection control was almost 80% lower in patients with degenerative disease. All screws were safely explanted while vertebral integrity was maintained. PMMA was not removed, and no recementing was done for new screws.
The success rate for treatment of deep infection after cemented spinal arthrodesis is high. Infection rate findings and the most commonly found pathogens do not differ between cemented and noncemented fusion. It does not appear that the use of PMMA in cementing vertebrae plays a pivotal role in the development of SSIs.
对前瞻性收集的结果进行回顾性观察研究。
使用聚甲基丙烯酸甲酯（PMMA）增强的椎弓根螺钉是骨质疏松性椎体患者的一种替代方法。探讨在接受择期器械脊柱融合术（ISF）的患者中使用PMMA增强螺钉是否与感染风险增加以及手术部位感染（SSI）后这些脊柱植入物的长期存活相关。
我们研究了537例在9年期间内某一时刻接受ISF的连续患者，共涉及2930枚PMMA增强螺钉。患者分为以下几组：（1）通过冲洗、手术清创和抗生素治疗治愈感染的患者；（2）通过取出或更换内固定物治愈感染的患者；（3）治疗失败的患者。
537例患者中有28例（5.2%）在ISF后发生SSI。19例（4.6%）患者在初次手术后发生SSI，9例（7.25%）在翻修手术后发生SSI。11例患者（39.3%）感染革兰氏阳性菌，7例（25%）感染革兰氏阴性菌，10例（35.7%）感染多种病原体。术后2年时，23例患者（82.15%）的感染已治愈。尽管术前诊断之间的感染发生率无统计学显著差异（P = 0.178），但退行性疾病患者因控制感染而需要取出内固定物的比例几乎低80%。所有螺钉均安全取出，同时维持了椎体完整性。未取出PMMA，也未对新螺钉进行再次骨水泥固定。
骨水泥脊柱融合术后深部感染的治疗成功率较高。骨水泥融合和非骨水泥融合的感染率结果及最常见病原体无差异。在椎体骨水泥固定中使用PMMA似乎在SSIs的发生中不起关键作用。
