Ren Shiwei, Liu Huan, Chang Zhengqi
Department of Orthopaedics, the 960th Hospital of PLA, 25 shifan Road, Tianqiao District, Jinan, Shandong, 250031, China.
J Orthop Surg Res. 2025 Jan 13;20(1):44. doi: 10.1186/s13018-025-05463-2.
One of the common complications in spinal surgery patients is deep surgical site infections (SSIs). Deep SSIs refer to infections that involve the deeper soft tissues of the incision, such as the fascia and muscle layers. This complication can lead to prolonged hospitalization, repeated surgeries, and even life-threatening conditions. In recent years, Negative Pressure Wound Therapy (NPWT) has been widely used as an effective wound healing method in the management of post-surgical infections. However, there is a lack of systematic research and comprehensive reviews regarding the exact effectiveness of NPWT in the treatment of deep SSIs following spinal surgery. Therefore, we conducted this meta-analysis to explore the efficacy of NPWT in treating deep SSIs after spinal surgery, aiming to provide clearer evidence to support clinical practice.
A comprehensive search of databases, including CNKI, Wanfang data, VIP data, CBM, PubMed, Embase, Cochrane Library, and Web of Science, was conducted for studies up to August 20, 2024, examining the use of NPWT in treating SSIs after spinal surgery. Using Stata 15.0 software, we employed either fixed or random models to calculate combined effect sizes, depending on the level of heterogeneity observed.
Of the 571 publications initially screened, 19 studies meeting the inclusion criteria were selected for analysis. The meta-analysis revealed that the mean duration of vacuum sealing drainage (VSD) treatment was 17.45 days [95% confidence interval (CI) (11.63 days, 23.28 days)], and the mean number of VSD uses was 2.57 times[95% CI (1.53times, 3.60times)]. Additionally, the recurrence rate of infection post-discharge was 2% (95% CI = 0-4%). The reoperation rate for internal fixation in NPWT-treated patients was 4% (95% CI = 0-14%).
Available evidence supports the effectiveness of NPWT in treating deep SSIs following spinal surgery, suggesting its clinical utility. However, further studies are needed to compare NPWT with other treatment options for SSIs management.
PROSPERO CRD42024612412.
脊柱手术患者常见的并发症之一是手术部位深部感染（SSIs）。深部SSIs是指涉及切口更深层软组织的感染，如筋膜和肌肉层。这种并发症可导致住院时间延长、重复手术，甚至危及生命的情况。近年来，负压伤口治疗（NPWT）作为一种有效的伤口愈合方法已被广泛应用于手术后感染的管理。然而，关于NPWT在脊柱手术后深部SSIs治疗中的确切有效性，缺乏系统的研究和全面的综述。因此，我们进行了这项荟萃分析，以探讨NPWT在脊柱手术后深部SSIs治疗中的疗效，旨在提供更明确的证据支持临床实践。
全面检索数据库，包括中国知网、万方数据、维普数据、中国生物医学文献数据库、PubMed、Embase、Cochrane图书馆和Web of Science，检索截至2024年8月20日的研究，这些研究探讨了NPWT在脊柱手术后SSIs治疗中的应用。使用Stata 15.0软件，根据观察到的异质性水平，采用固定或随机模型计算合并效应量。
在最初筛选的571篇文献中，选择了19项符合纳入标准的研究进行分析。荟萃分析显示，负压封闭引流（VSD）治疗的平均持续时间为17.45天[95%置信区间（CI）（11.63天，23.28天）]，VSD使用的平均次数为2.57次[95%CI（1.53次，3.60次）]。此外，出院后感染复发率为2%（95%CI = 0 - 4%）。NPWT治疗患者的内固定再次手术率为4%（95%CI = 0 - 14%）。
现有证据支持NPWT在脊柱手术后深部SSIs治疗中的有效性，表明其临床实用性。然而，需要进一步研究将NPWT与其他SSIs管理治疗方案进行比较。
PROSPERO CRD42024612412。
