局部应用万古霉素预防腰椎后路融合内固定术后切口感染的效果及对融合率的影响

The effect of local application of vancomycin powder after posterior lumbar interbody fusion surgery on prevention of surgical site infection and fusion rate

中文关键词:  腰椎手术  万古霉素  局部用药  切口感染  融合

英文关键词:Lumbar spine surgery  Vancomycin  Topical administration  Surgical site infection  Fusion

中文摘要:

  【摘要】 目的：评价局部应用万古霉素预防腰椎后路融合内固定术后切口感染的效果及对融合率的影响。方法：回顾性分析2013年1月~2014年12月于我院行腰椎后路融合内固定术的569例患者。排除标准：无内置物微创手术；胸腰段畸形手术；入院前3个月内有感染史；头孢类及万古霉素过敏等；随访少于12个月；术后未复查腰椎正侧位X线片及CT三维重建。采用常规腰椎后路围手术期预防感染方案（术前1h静脉应用头孢呋辛钠2.0g，术中每隔4h追加2.0g，术后24h内给予2.0g）患者纳入对照组（A组，n=363），男195例，女168例，年龄51.5±19.4岁，其中≥55岁162例，＜55岁201例，平均体重指数（BMI）28.1±6.7kg/m2，吸烟80例，不吸烟283例；采用常规预防感染方案的同时在关闭切口前术野局部应用万古霉素1g患者纳入万古霉素组（B组，n=206），男98例，女108例，年龄53.7±18.6岁，其中≥55岁99例，＜55岁107例，平均BMI 30.2±7.1kg/m2，吸烟37例，不吸烟169例。两组比较，性别、年龄、BMI、吸烟情况、并存病（糖尿病、高血压、心脏病、肺部疾病）、既往腰椎手术史、手术时间、术中出血量、术后置管率、引流管留置时间、术后引流量、融合节段数、住院时间等差异均无统计学意义（P＞0.05）。比较两组术后切口感染情况以及椎间融合情况。结果：B组共感染8例（3.88%），显著低于A组的30例（8.26%）（P=0.044）。B组中葡萄球菌4例（1.94%）、耐甲氧西林金黄色葡萄球菌1例（0.49%），显著少于A组的20例（5.51%）及13例（3.58%）（P＜0.05）；感染非葡萄球菌中，B组4例（1.94%）与A组10例（2.75%）差异无统计学意义（P＞0.05）。两组术后12个月椎间融合良好，差异无统计学意义（P＞0.05）。B组未出现肾毒性及耳毒性并发症。结论：局部预防性应用万古霉素能显著降低腰椎后路融合内固定术后切口感染率，同时对术后融合率没有影响。

英文摘要:

  【Abstract】 Objectives: To assess the effect of local application of vancomycin powder after posterior lumbar interbody fusion surgery on prevention of surgical site infection(SSI) and fusion rate. Methods: From January 2013 to December 2014, 569 cases undergoing posterior lumbar interbody fusion surgery in PLA General Hospital were analyzed retrospectively. Exclusion criteria included mimimally invasive surgeries without implants, spinal deformity surgeries refered to thoracolumbar vertebrae, previous history of infections in three months before hospitalization, patients allergic to vancomycin or cephalosporin antibiotics, patients with a postoperative follow-up of less than 12 months, lack of postoperative X-ray and computed tomography(CT) examination. Patinents receiving the routine scheme for preventing SSI were assigned into non-vanco group(group A, n=363). There were 195 males and 168 females; the average age was 51.5±19.4 years, with 162 cases ≥55 years and 201 cases ＜55 years; the average BMI was 28.1±6.7kg/m2; there were 80 smokers and 283 non-smokers. Patients in group B received the routine scheme and local application of vancomycin powder 1g(n=206). There were 98 males and 108 females; the average age was 53.7±18.6 years, with 99 cases ≥55 years and 107 cases ＜55 years; the average BMI was 30.2±7.1kg/m2; there were 37 smokers and 169 non-smokers. There was no statistical difference in sex, age, BMI, smoking, comorbidities(diabetes, hypertension, cardiovasculardisease, respiratory disease), history of lumbar surgery, operation time, blood loss, hemovac drain usage, hemovac drain time, volume of drainage, number of levels instrumented or number of days hospitalization between the two groups(P＞0.05). The situations of SSI and fusion were compared between the two groups. Results: Total SSI decreased to 8 cases(3.88%) in vanco group(group B) compared with 30 cases(8.26%) in non-vanco group(P=0.044). Staphylococcal infection presented in 4 patients(1.94%) with deep methicillin-resistant staphylococcus aureus(MRSA) infection in 1 patient(0.49%) in group B, which decreased statistically significantly compared with 20 patients(5.51%) and 13 patients(3.58%) in group A(P＜0.05). There was no statistically significant difference in non-staphylococcal infection between 4 patients(1.94%) in group B and 10 patients(2.75%) in group A(P=0.547). There was no significant difference in fusion rate between the two groups at 12 months postoperatively(P＞0.05). No complications such as renal toxicity and ototoxicity were observed in vanco group. Conclusions: SSI rate decreases significantly through the local application of intrawound vancomycin powder after posterior lumbar interbody fusion surgery. Meantime, no effect on fusion rate is observed.