Viola R W, King H A, Adler S M, Wilson C B
Department of Orthopaedics, University of Washington, Seattle, USA.
Spine (Phila Pa 1976). 1997 Oct 15;22(20):2444-50; discussion 2450-1. doi: 10.1097/00007632-199710150-00023.
A retrospective analysis of eight cases of delayed spinal infection after elective posterior or combined anterior and posterior spinal instrumentation and fusion.
These cases are reviewed to identify risk factors for delayed spinal infection after elective instrumentation and to describe the treatment of this complication.
Delayed spinal infection after elective spinal instrumentation and fusion is uncommon. This diagnosis is frequently difficult.
Five cases seen in the senior author's practice and three referral cases are reviewed.
Of these eight cases, the organisms were Staphylococcus epidermidis in six cases, Propionibacterium acnes in one cases, and in the final patient, all intraoperative cultures were negative. Clinical presentations were variable; however, all patients reported back pain. Seven patients had elevated erythrocyte sedimentation rates, averaging 57 mm/hour. Only two had elevated white blood cell counts. No distant foci of infection were identified in any patient. Five-patients were found to have at least one pseudarthrosis. All patients were treated with debridement, instrumentation removal, and primary wound closure over drains followed by a minimum 6-week course of culture-directed postoperative antibiotics. At an average follow-up of 18 months, no patient has evidence of infection.
The diagnosis of delayed infection after elective spinal instrumentation and fusion requires a high index of suspicion. These infections may have been caused by intraoperative inoculation. All patients were successfully treated with debridement, instrumentation removal, and culture-directed postoperative antibiotics.
对8例择期后路或前后路联合脊柱内固定及融合术后迟发性脊柱感染病例进行回顾性分析。
回顾这些病例以确定择期脊柱内固定术后迟发性脊柱感染的危险因素，并描述该并发症的治疗方法。
择期脊柱内固定及融合术后迟发性脊柱感染并不常见。这种诊断通常很困难。
回顾了资深作者所诊治的5例病例以及3例转诊病例。
在这8例病例中，6例的病原体为表皮葡萄球菌，1例为痤疮丙酸杆菌，最后1例患者术中所有培养结果均为阴性。临床表现各异；然而，所有患者均报告有背痛。7例患者红细胞沉降率升高，平均为57毫米/小时。只有2例白细胞计数升高。所有患者均未发现远处感染灶。5例患者被发现至少有1处假关节形成。所有患者均接受了清创、取出内固定物、在引流管留置的情况下一期缝合伤口，随后接受至少6周的根据培养结果指导的术后抗生素治疗。平均随访18个月时，所有患者均无感染迹象。
择期脊柱内固定及融合术后迟发性感染的诊断需要高度怀疑。这些感染可能是由术中接种引起的。所有患者通过清创、取出内固定物及根据培养结果指导的术后抗生素治疗均获得成功。
