[1]周孝聪,赵学凌,雷宇,等.胸腰椎后路内固定术后深部感染的研究进展[J].中华老年骨科与康复电子杂志,2019,(01):54-57.[doi:10.3877/cma.j.issn.2096-0263.2019.01.010]
 Zhou Xiaocong,Zhao Xueling,Lei Yu,et al.Progress of postoperative infection after lumbar posterior surgery[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(01):54-57.[doi:10.3877/cma.j.issn.2096-0263.2019.01.010]
点击复制

胸腰椎后路内固定术后深部感染的研究进展()
分享到:

中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年01期
页码:
54-57
栏目:
综述
出版日期:
2019-02-05

文章信息/Info

Title:
Progress of postoperative infection after lumbar posterior surgery
作者:
周孝聪赵学凌雷宇杨鸿超杨少茼张源
650000 昆明医科大学第一附属医院骨科
Author(s):
Zhou Xiaocong Zhao Xueling Lei Yu Yang Hongchao Yang Shaotong Zhang Yuan
Department of Orthopaedics, the First Affiliated Hospital of Kunming Medical University, Kunming 650000, China
关键词:
腰椎 外科伤口感染 负压封闭引流技术
Keywords:
Lumbar vertebrae Surgical wound infection Vacuum suction drainage
DOI:
10.3877/cma.j.issn.2096-0263.2019.01.010
文献标志码:
A
摘要:
胸腰椎后路内固定术后深部感染作为脊柱外科最严重并发症之一,不仅延长住院时间、增加治疗费用,而且会显著增高感染相关的并发症发生率和死亡率。如何在保留内植物维持脊柱稳定的同时, 又有效的控制感染,成为脊柱外科医生共同面临的严峻挑战。本研究就胸腰椎后路内固定术后发生深部感染的易感因素,术前积极采取相应措施以减少其对手术的影响,术中严格遵守无菌原则,术后密切观察患者各项指标,以及如何进行术后感染的及时诊断、选择适当的治疗方案等方面进行了详细介绍,以期为临床上降低感染率、提高治愈率提供参考。
Abstract:
Deep infection after thoracolumbar posterior internal fixation is one of the most serious complications of spinal surgery, which not only prolongs hospitalization time, increases treatment costs, but also significantly increases the incidence of infection-related complications and mortality. How to maintain the stability of the spine while retaining the internal plants and effectively control the infection has become a serious challenge for spine surgeons. This study explained some relative deep infection factors, such as the susceptibility factors of deep infection after thoracolumbar posterior internal fixation, corresponding measures to reduce the impact on the operation, strict adherence to the principle of sterility during operation, and close observation of patients’ indexes after operation, and timely diagnosis of postoperative infection, appropriate treatment plan, etc., expecting to provide a reference for clinical reduction of infection rate and improvement of cure rate.

参考文献/References:

1 Levi AD, Dickman CA, Sonntag VK. Management of postoperative infections after spinal instrumentation [J]. J Neurosurg, 1997, 86(6): 975-980.
2 马振江, 赵杰, 娄伟刚, 等. 脊柱手术部位感染的危险因素及预防措施研究进展 [J]. 中国脊柱脊髓杂志, 2014, 24(3): 279-283.
3 Pull Ter Gunne AF, Hosman AJ, Cohen DB, et al. A methodological systematic review on surgical site infections following spinal surgery: part 1: risk factors [J]. Spine (Phila Pa 1976), 2012, 37(24): 2017-2033.
4 Savage K, Holtom PD, Zalavras CG. Spinal epidural abscess: early clinical outcome in patients treated medically [J]. Clin Orthop Relat Res, 2005 (439): 56-60.
5 Brady RA, Leid JG, Calhoun JH, et al. Osteomyelitis and the role of biofilms in chronic infection [J]. FEMS Immunol Med Microbiol, 2008, 52(1): 13-22.
6 Tattevin P, Cre´mieux A-C, Pottier P, et al. Prosthetic joint infection: when can prosthesis salvage be considered? [J]. Clin Infect Dis, 1999, 29(2): 292-295.
7 Petilon JM, Glassman SD, Dimar JR, et al. Clinical outcomes after lumbar fu-sion complicated by deep wound infection: a case-control study [J]. Spine (Phila Pa 1976), 2012, 37(16): 1370-1374.
8 Wimmer C, Gluch H, Franzreb M, et al. Predisposing factors for infection in spine surgery: A survey of 850 spinal procedures [J]. J Spinal Disord, 1998, 11(2): 124-128.
9 Di Silvestre M, Bakaloudis G, Lolli FA, et al. Late-developing infection following posterior fusion for adolescent idiopathic scoliosis [J]. Eurn Spine J, 2011, 20(1): 121-127.
10 王岩, 张雪松, 肖嵩华, 等. 脊柱内固定术后深部感染 [J]. 中华医学杂志, 2006, 86(25): 1737-1739.
11 National?Nosocomial Infections?Surveillance?System. National nosocomial infections surveillance system National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004 [J]. Am J Infect Control, 2004, 32(8): 470-485.
12 Fang A, Hu SS, Endres N, et al. Risk factors for infection after spinal surgery [J]. Spine (Phila Pa 1976), 2005, 30(12): 1460-1465.
13 Olsen MA, Mayfield J, Lauryssen C, et al. Risk factors for surgical site infection in spinal surgery [J]. J Neurosurg, 2003, 98(2 Suppl): 149-155.
14 Olsen MA, Nepple JJ, Riew KD, et al. Risk factors for surgical site infection following orthopaedic spinal operations [J]. J Bone Joint Surg Am, 2008, 90(1): 62-69.
15 Pull ter Gunne AF. Cohen DB. Incidence, prevalence, and analysis of risk factors for surgical site infection following adult spinal surgery [J]. Spine (Phila Pa 1976), 2009, 34(13): 1422-1428.
16 张志平, 郭昭庆, 齐强, 等. 胸腰椎后路术后深部手术切口感染的危险因素分析 [J]. 中华外科杂志, 2015, 53(5): 345-348.
17 Parker SL, Adogwa O, Witham TF, et al. Post-Operative infection after minimally invasive versus open transforaminal lumbar interbody fusion (TLIF): literature review and cost analysis [J]. Minim Invasive Neurosurg, 2011, 54(1): 33-37.
18 Friedman ND, Sexton DJ, Connelly SM. Risk factors for surgical site infection complicating laminectomy [J]. Infect Control Hosp Epidemiol, 2007, 28(9): 1060-1065.
19 Carragee EJ. Pyogenic vertebral osteomyelitis [J]. J Bone Joint Surg Am, 1997, 79(6): 874-880.
20 Viola RW, King HA, Adler SM, et al. Delayed infection after elective apinal instumentation and Fusion.A retrospective analysis of eight cases [J]. Spine (Phila Pa 1976), 1997, 22(20): 2444-2450.
21 Abdul-Jabbar A, Takemoto S, Weber MH, et al. Surgical site infection in spinal surgery: description of surgical and patient-based risk factors for postoperative infection using administrative claims data [J]. Spine (Phila Pa 1976), 2012, 37(15): 1340-1345.
22 Tominaga H, Setoguchi T, Kawamura HA, et al. Risk factors for unavoidable removal of instrumentation after surgical site infection of spine surgery: A retrospective case-control study [J]. Medicine, 2016, 95(43): e5118.
23 Koutsoumbelis S, Hughes AP, Girardi FP, et al. Risk factors for postoperative infection following posterior lumbar instrumented arthrodesis [J]. J Bone Joint Surg Am, 2011, 93 (17): 1627-1633.
24 Ogihara S, Yamazaki T, Maruyama T, et al. Prospective multicenter surveillance and risk factor analysis of deep surgical site infection after posterior thoracic and/or lumbarspinal surgery in adults [J]. J Orthop Sci, 2015, 20(1): 71-77.
25 Maragakis LL, Cosgrove SE, Martinez EA, et al. Intraoperative fraction of inspired Oxygen is a modifiable risk factor for surgical site infection after spinal surgery [J]. Anesthesiology, 2009, 110(3): 556-562.
26 Kasliwal MK, Tan LA, Traynelis VC. Infection with spinal instrumentation: Review of pathogenesis, diagnosis, prevention, and management [J]. Surg Neurol Int, 2013, 4(Suppl 5): S392-S403.
27 Cassinelli EH, Eubanks J, Vogt M, et al. Risk factors for the development of perio-perative complications in elderly patients undergoing lumbar decompression and arthrodesis f-or spinal stenosis:an analysis of 166 patients [J]. Spine (Phila Pa 1976), 2007, 32(2): 230-235.
28 Patel N, Bagan B, Vadera S, et al. Obesity and spine surgery: relation to perioperative complications [J]. J Neurosurg Spine, 2007, 6(4): 291-297.
29 Peng CW, Bendo JA, Goldstein JA, et al. Perioperative outcomes of anterior lumbar surgery in obese versus non-obese patients [J]. Spine J, 2009, 9(9): 715-720.
30 Ferry T, Valour F, Lustig S, et al. The challenge of infection prevention in spine surgery:an update [J]. Eur J Orthop Surg Traumatol, 2013, 23(Suppl 1): S15-S19.
31 Hikata T, Iwanami A, Hosogane N, et al. High preoperative hemoglobin A1c is a risk factor for surgical site infection after posterior thoracic and lumbar spinal instrumentation surgery [J]. J Orthop Sci, 2014, 19(2): 223-228.
32 Glotzbecker MP, Riedel MD, Vitale MG, et al. What’s the evidence? systematic literature review of risk factors and preventive strategies for surgical site infection following pediatric spine surgery [J]. J Pediatr Orthop, 2013, 33(5): 479-487.
33 Mehta AI, Babu R, Sharma R, et al. Thickness of subcutaneous fat as a risk factor for infection in cervical spine fusion surgery [J]. J Bone Joint Surg Am, 2013, 95(4): 323-328.
34 Decoster TA, Bozorgnia S. Antibiotic beads [J]. J Am Acad Orthop Surg, 2008, 16(11): 674-678.
35 Watanabe M, Sakai D, Matsuyama D, et al. Risk factors for surgical site infection following spine surgery: efficacy of intraoperative saline irrigation [J]. J Neurosurg Spine, 2010, 12(5): 540-546.
36 Blam OG, Vaccaro AR, Vanichkachorn JS, et al. Risk factors for surgical site infection in the patient with spinal injury [J]. Spine (Phila Pa 1976), 2003, 28(13): 1475-1480.
37 Rao SB, Vasquez G, Harrop J, et al. Risk factors for surgical site infections following spinal fusion procedures: a case-control study [J]. Clin Infect Dis, 2011, 53(7): 686-692.
38 Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees [J]. J Bone Joint Surg Am, 2013, 95(9): 775-782.
39 Song KH, Kim ES, Kim YK, et al. Differences in the risk factors for surgical site infection between total hip arthroplasty and total knee arthroplasty in the Korean Nosocomial Infections Surveillance System (KONIS) [J]. Infect Control Hosp Epidemiol, 2012, 33(11): 1086-1093.
40 Kim ES, Kim HB, Song KH, et al. Prospective nationwide surveillance of surgical site infections after gastric surgery and risk factor analysis in the Korean Nosocomial Infections Surveillance System (KONIS) [J]. Infect Control Hosp Epidemiol, 2012, 33(6): 572-850.
41 Glotzbecker MP, Vitale MG, Shea KG, et al. Surgeon practices regarding infection prevention for pediatric spinal surgery [J]. J Pediatr Orthop, 2013, 33(7): 694-699.
42 Vitale MG, Riedel MD, Glotzbecker MP, et al. Building consensus: development of a Best Practice Guideline (BPG) for surgical site infection (SSI) prevention in high-risk pediatric spine surgery [J]. J Pediatr Orthop, 2013, 33(5): 471-478.
43 Linam WM, Margolis PA, Staat MA, et al. Risk factors associated with surgical site infection after pediatric posterior spinal fusion procedure [J]. Infect Control Hosp Epidemiol, 2009, 30(2): 109-116.
44 Jahoda D1, Nyc O, Pokorný D, et al. Antibiotic treatment forprevention of infectious complications in joint replacement [J]. Acta Chir Orthop Traumatol Cech, 2006, 73(2): 108-114.
45 刘昱彰, 张世民, 董福慧, 等. 椎间隙灌洗法治疗腰椎后路内固定术后切口早期深部感染的疗效分析 [J]. 中国骨伤, 2012, 0(10): 866-869.
46 陈勇喜, 农新盛, 黄超, 等. 负压封闭引流技术治疗脊柱内固定术后伤口深部感染12例 [J]. 广西医科大学学报, 2013, 30(2): 306-307.
47 Bhagat S, Mathieson C, Jandhyala R, et al. Spondylodiscitis (dise space infectio-n) associated with negative mierobiological tests: comparison of outcome of suspected dise space infection to documented non-tuberculous pyogenie discitis [J]. Br Neurosurg, 2007, 21(5): 473-477.
48 吴五洲, 孙艳玲, 王达义, 等. 腰椎间盘术后椎间隙感染的诊治分析 [J]. 颈腰痛杂志, 2008, 29(6): 552-554.
49 Femandez M, Carrol C, Baker CJ. Discitis and vertebral osteomyelitis in children: an 18-year review [J]. Pediatrics, 2000, 105(6): 1299-1304.
50 Floccari LV, Milbrandt TA. Surgical site infections after pediatric spine surgery [J]. Orthop Clin North Am, 2016, 47(2): 387-394.
51 Chen SH, Lee CH, Huang KC, et al. Postoperative wound infection after posterior spinal instrumentation: analysis of long-termtreatment outcomes [J]. Eur Spine J, 2015, 24(3): 561-570.
52 Hedequist D, Haugen A, Hresko T, et al. Failure of attempted implant retention in spinal deformity delayed surgical site infections [J]. Spine (Phila Pa 1976), 2009, 34(1): 60-64.
53 Garg S, LaGreca J, hotchkiss M, et al. Management of late (>1 y) deep infection after spinal fusion: a retrospective cohort study [J]. J Pediatr Orthop, 2015, 35(3): 266-270.
54 严峻, 郑勇, 谢耀杰, 等. 胸腰椎后路术后切口感染的治疗策略 [J]. 颈腰痛杂志, 2016, 37(2): 115-118.

相似文献/References:

[1]邵明昊 吕飞舟 马晓生 夏新雷 王洪立 郑超君 张帆 姜建元.腰椎皮质骨钉道螺钉在骨质疏松症患者中 应用的三维有限元分析[J].中华老年骨科与康复电子杂志,2015,(02):1.[doi:10.3877/cma.j.issn.2096-0263.2015.02.001]
 Shao Minghao,Lyu Feizhou,Ma Xiaosheng,et al.Biomechanical evaluation of lumbar pedicle screws using cortical bone trajectory in osteoporosis : a finite element study[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2015,(01):1.[doi:10.3877/cma.j.issn.2096-0263.2015.02.001]
[2]王玉,岳斌,张国庆,等.退行性腰椎滑脱稳定性与手术复位率的相关性分析[J].中华老年骨科与康复电子杂志,2016,(04):198.[doi:10.3877/cma.j.issn.2096-0263.2016.04.002]
 Wang Yu,Yue Bin,Zhang Guoqing,et al.Correlation analysis between stability of the degenerative lumbar spondylolisthesis and the reduction rate in aged patients[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):198.[doi:10.3877/cma.j.issn.2096-0263.2016.04.002]
[3]黄伟敏,于秀淳,梁进,等.PEEK棒椎弓根螺钉系统治疗老年腰椎退行性疾病的疗效分析[J].中华老年骨科与康复电子杂志,2016,(04):211.[doi:10.3877/cma.j.issn.2096-0263.2016.04.004]
 Huang Weimin,Yu Xiuchun,et al.Clinical outcome of PEEK rod pedicle screw system for senile lumbar degenerative disease[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2016,(01):211.[doi:10.3877/cma.j.issn.2096-0263.2016.04.004]
[4]陈宏亮,郭开今,段钢,等.单侧椎弓根旁入路PKP治疗腰椎OVCF的临床疗效观察[J].中华老年骨科与康复电子杂志,2021,(03):140.[doi:10.3877/cma.j.issn.2096-0263.2021.03.003]
 Chen Hongliang,Guo Kaijin,Duan Gang,et al.Clinical observation of unilateral-beside approach PKP in treatment of lumbar OVCF[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2021,(01):140.[doi:10.3877/cma.j.issn.2096-0263.2021.03.003]
[5]曾忠友,张建乔,宋永兴,等.斜外侧入路和后路融合治疗Ⅰ~Ⅱ度腰椎滑脱症的对比研究[J].中华老年骨科与康复电子杂志,2022,(02):80.[doi:10.3877/cma.j.issn.2096-0263.2022.02.003]
 Zeng Zhongyou,Zhang Jianqiao,Song Yongxing,et al.Comparative study of oblique lateral approach and posterior fusion in the treatment of grade Ⅰ-Ⅱ lumbar spondylolisthesis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2022,(01):80.[doi:10.3877/cma.j.issn.2096-0263.2022.02.003]
[6]王海宾,刘恩,吕飞,等.斜外侧腰椎椎间融合术治疗退行性腰椎管狭窄的疗效分析[J].中华老年骨科与康复电子杂志,2022,(04):224.[doi:10.3877/cma.j.issn.2096-0263.2022.04.006]
 Wang Haibin,Liu En,Lyu Fei,et al.Clinical analysis of oblique lateral lumbar interbody fusion in the treatment of degenerative lumbar spinal stenosis[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2022,(01):224.[doi:10.3877/cma.j.issn.2096-0263.2022.04.006]

备注/Memo

备注/Memo:
基金项目: 国家自然科学基金资助项目(81560366)
更新日期/Last Update: 2019-02-25