脊柱术后伤口感染

影像学的帮助
临床症状体征很重要：严重的伤口疼痛，头
痛，精神状态改变，新出现的神经病损
感染诊断时间
36/1,568（ 2.2%）早期13.5天（10-21天），
迟发4例
J. J. P. Schimmel • P. P. Horsting • M. de Kleuver •G. Wonders • J. van Limbeek Risk factors for deep surgical site infections after spinal fusion Eur Spine J (2010) 19:1711–1719
36/1,568（ 2.2%）
J. J. P. Schimmel • P. P. Horsting • M. de Kleuver •G. Wonders • J. van Limbeek Risk factors for deep surgical site infections after spinal fusion Eur Spine J (2010) 19:1711–1719

危险因素-手术时间
Surgical literature documents that
operations lasting longer than 5 hours have increased wound-infection rates

Johnston, D. H., Fairclough, J. A,, and Brown. E. M.: Microbial surveillance in the surgical intensive care unit. Surg. Gynecol. Obstet. I39:32 1, 1974
深部感染诊断
文献报道术后平均11天的发现期
局部早期可能无症状，患者有全身不适的症
状，继而伤口痛，发热，寒战等，体检伤口 叩痛 局部穿刺和细菌GRAM染色确诊，亦有可能 阴性 WBC及ESR上升

Keller, R. B., and Pappas, A. M.: Infections after spinal fusion using internal fixation instrumentation. Orthop. Clin. North Am. 3:99, 1972
内容摘要
ቤተ መጻሕፍቲ ባይዱ义
流行病学 影响因素
病原学
预防
治疗措施
需要关注的问题
Surgical Site Infection (SSI)
SSI was defined as: any postoperative wound that
required treatment with oral or intravenous antibiotics or surgical debridement
脊柱术后伤口感染 原因及治疗策略
北京大学第三医院骨科 田耘
Surgical Site Infection (SSI)
SSI意味着医生的痛苦、
患者的眼泪 高病残率，成倍增加的 花费
Because the medical,economic and social costs of SSI are enormous， any significant reduction in risks will pay dividends

SSI的定义
手术区出现渗出，可培养出一种或多种致病
菌 A wound infection was defined as presence of purulence at the operative site and a microbiologic culture positive for one or more organisms

危险因素
吸烟史 smoking showed a significant difference between the groups 肥胖 A nearly significant difference was found in the categorized BMI 多节段固定 in the infected group a larger portion of surgeries involved four or more levels (42%),

危险因素
糖尿病 In the final model diabetes had the
strongest association with SSI 既往手术史 a positive history of previous spinal surgery had a strong association with the occurrence of an infection, with an odds ratio of 3.70

致病菌
The most common organism cultured was

J. J. P. Schimmel • P. P. Horsting • M. de Kleuver •G. Wonders • J. van Limbeek Risk factors for deep surgical site infections after spinal fusion Eur Spine J (2010) 19:1711–1719
流行病学
手术切口区感染是脊柱手术经常出现的并发
症 发生率，文献报道0.7～12%。 46/830 (5.0%), Albert F. Pull ter Gunne • C. J. H. M. van
Laarhoven •David B. Cohen Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk Eur Spine J (2010) 19:982–988

流行病学
无内固定0.41% (25 /6108) ,有内固定者感染发生率为
1.0%(11 /1112) ,总体感染发生率为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；43：229-231
1.61%（15/924）
仉建国 李书纲 杨新宇 田野 邱贵兴 脊柱侧凸后路矫形融合术术后感染的治疗 中华骨科杂志 2001；21：453-456
任何术后伤口需要进行口服或静脉使用抗生素，或
者需要外科手术清理者
Albert F. Pull ter Gunne • C. J. H. M. van Laarhoven •David B. Cohen Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk Eur Spine J (2010) 19:982–988
J. J. P. Schimmel • P. P. Horsting • M. de Kleuver •G. Wonders • J. van Limbeek Risk factors for deep surgical site infections after spinal fusion Eur Spine J (2010) 19:1711–1719

SSI的危险因素
高龄 肥胖 糖尿病
其他伴随疾病
吸烟 身体状况差
完全的神经功能损伤
SSI的高危因素-手术因素
翻修手术 肿瘤手术 出血多
手术时间长
多节段
危险因素
Obesity (P = 0.035) and history of prior SSI
SSI 的症状
present with at least one of the classical signs of
inflammation (pain, swelling, redness, increased local temperature) drainage of purulent fluid from the operating incision, spontaneous wound dehiscention or an abces or other signs of infection at observation, reoperation, histo-pathological or radiological investigation

JENNIFERB . MASSIE B, S Postoperative Posterior Spinal Wound Infections。Clinical Orthopaedics and Related Research 1992；284： 99-108
Surgical site infections (SSI) CDC criteria (Centres for Disease Control and prevention)

危险因素-手术时间
an increased operating time will result in
significant increased risk for SSI
Pull ter Gunne AF, Cohen DB (2009) Incidence, prevalence and analysis of risk factors for surgical site infection following adult spinal surgery. Spine (in press）
感染的诊断
表浅伤口：红肿，压痛，积液渗出
GRAM染色和培养
ESR增快

Keller, R. B., and Pappas, A. M.: Infections after spinal fusion using internal fixation instrumentation. Orthop. Clin. North Am. 3:99, 1972
(P = 0.045) significantly increased the risk of SSI
Albert F. Pull ter Gunne • C. J. H. M. van Laarhoven •David B. Cohen Incidence of surgical site infection following adult spinal deformity surgery: an analysis of patient risk Eur Spine J (2010) 19:982–988
J. J. P. Schimmel • P. P. Horsting • M. de Kleuver •G. Wonders • J. van Limbeek Risk factors for deep surgical site infections after spinal fusion Eur Spine J (2010) 19:1711–1719
手术区域的感染发生于术后30天内，或有内固定的患 者术后1年内出现的感染。

An infection was considered to be a surgical site infection when it occured at the site of the surgery within 30 days after the operation or within 1 year if the operation included placement of a foreign body, e.g. an implant.