脊柱术后感染

The cause and treatment of Postoperative spinal wound infection,Min Zhou MD,脊柱术后伤口感染的原因与治疗策略,1,Surgical site infection(SSI),Defined: any postoperative wound that required treatment with oral or intravenous antibiotics or surgical debridement任何术后伤口需要口服或静脉使用抗生素，或者需要外科手术清理者Pull ter Gunne AF1, van Laarhoven CJ, Cohen DB.Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J. 2010 Jun; 19(6): 982988.,2,Epidemiology,无内固定0.41%（25/6108），有内固定者感染发生率1.0%（11/1112），总体感染发生率0.5%（36/7220）田耘 ，陈仲强 ，周方 ，刘忠军 ；脊柱术后伤口深部感染的处理.中华外科杂志 ,2005 ,43 (4) :229-231,3,手术切口区感染是脊柱手术常见的并发症发生率，文献报道0.7-12%46/830（5.0%），Pull ter Gunne AF1, van Laarhoven CJ, Cohen DB.Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk. Eur Spine J. 2010 Jun; 19(6): 982988. 36/1568（2.2%），Schimmel JJ1, Horsting PP, de Kleuver M, Wonders G, van Limbeek J. Risk factors for deep surgical site infections after spinal fusion. Eur Spine J. 2010 Oct;19(10):1711-1719.,4,Risk factors,5,6,Symptom,Present with at least one of the classical signs of inflammation (pain ,swelling ,redness ,increased local temperature)红肿热痛，体温升高Drainage of purulent fluid from the operating incision , spontaneous wound dehiscence or other signs of infection.伤口流脓，裂开及其他感染征象,7,Diagnosis,文献报道术后平均11天的发现期早期局部可能无症状，患者有全身不适症状，继而伤口痛，发热，寒战等，伤口体检伴叩击痛局部穿刺和细菌培养确诊，亦有可能阴性WBC及ESR上升影像学帮助临床症状体征的重要性：严重的伤口疼痛，头痛，精神状态的改变，新出现的神经病损,8,Therapy,术前预防1.术者手和手臂的标准消毒2.患者术前洗澡和会阴冲洗3.术前即刻应用抗生素Treatment of the suspected infection should be prompt ,aggressive ,and surgical疑似感染者需及时，积极，手术Antibiotic treatment is usually adjunctive and follows definitive surgical debridement及时使用抗生素,9,Intrawound application of vancomycin after elective spine surgery was not associated with reduced risk of SSI术中伤口内使用万古霉素对降低脊柱术后伤口感染无统计学意义Mirzashahi B , Chehrassan M ,Mortazavi SMJ . Intrawound application of vancomycin changes the responsible germ in elective spine surgery without significant effect on the rate of infection: a randomized prospective study. Musculoskelet Surg. 2017 Jul 11 : 10.1007,10,Early surgical intervention with incision ,irrigation ,and debridement早期外科手术:切开 ，冲洗 ，清创术Deep wound infections were closed over inflow-outflow tubes to allow continuous irrigation with fluid ,5-10days.引流，负压还是冲洗引流？保留时间？文献报道5天即可北京三院的经验，闭合冲洗引流，7-10天，伤口引流液培养阴