Kumar A, Wood G W, Whittle A P
Department of Orthopaedic Surgery, University of Tennessee-Campbell Clinic, Memphis, USA.
J Orthop Trauma. 1998 Sep-Oct;12(7):514-7. doi: 10.1097/00005131-199809000-00016.
To evaluate the risk of infection of the spine and associated complications after colonic or rectal injury associated with gunshot injury of the spine.
Retrospective review.
Presley Memorial Trauma Center, Regional Medical Center, Memphis, Tennessee, a statewide Level 1 trauma center.
Thirty-three patients with gunshot wounds to the spine and associated viscus injury were treated between 1989 and 1994; in thirteen, the bullet passed through the colon or rectum before damaging the spine.
Six patients received a single antibiotic (Cefotetan) and seven were given multiple antibiotics. Total duration of antibiotic treatment ranged from two to forty-three days.
None of the thirteen patients developed osteomyelitis or disc space infection. Most intraabdominal complications were secondary to dehiscence of colonic repair.
Because the magnitude of bacterial colonization of the vertebrae after colonic injury may not be high, a nonoperative approach to treatment of abdominal viscus injuries is appropriate in patients with gunshot wounds to the spine. Broad-spectrum antibiotic coverage for at least seven days appears to be effective in preventing spinal infection, but colonic injuries are associated with an increased incidence of intraabdominal abscess and peritonitis.
评估脊柱枪伤合并结肠或直肠损伤后脊柱感染及相关并发症的风险。
回顾性研究。
田纳西州孟菲斯市地区医疗中心普雷斯利纪念创伤中心，全州一级创伤中心。
1989年至1994年间，33例脊柱枪伤合并内脏损伤患者接受治疗；其中13例患者子弹在损伤脊柱前穿过结肠或直肠。
6例患者接受单一抗生素（头孢替坦）治疗，7例患者接受多种抗生素治疗。抗生素治疗总时长为2至43天。
13例患者均未发生骨髓炎或椎间盘间隙感染。大多数腹部并发症继发于结肠修复处裂开。
由于结肠损伤后椎骨细菌定植程度可能不高，对于脊柱枪伤患者，非手术治疗腹部内脏损伤是合适的。至少使用7天的广谱抗生素覆盖似乎能有效预防脊柱感染，但结肠损伤会增加腹腔脓肿和腹膜炎的发生率。
