摘要
在儿童脊柱畸形手术矫形后出现的并发症中,手术区域感染（surgical site infection,SSI）会引起较高的死亡率[1]。相关研究表明,SSI会使患儿住院时间延长,并且静脉使用抗生素治疗的疗程延长及清创、内固定去除以及伤口探查都会对患儿、患者家庭、手术医生以及医疗保障机构带来巨大负担[1-3]。目前,关于儿童脊柱畸形进行手术矫形后出现SSI的相关研究较少.
Surgical site infection （ SSI ） after pediatric spinal deformity surgery is a complication that results in a high morbidity. SSI can be divided into superficial and deep SSI, or acute and delayed SSI. The highly related risk factors include urinary or bowel incontinence, positive preoperative urine culture, inappropriate antibiotic prophylaxis, prominent implants, first-generation stainless steel implants and so on; the lowly related risk factors include malnutrition, obesity, blood loss, blood transfusion, increased number of levels fused, extension to the pelvis / sacrum, increased operative time, no use of drain and so on. Identification of the most common causative organisms is very important to guide antibiotic prophylaxis protocols and individualize treatment regimens. Acute SSI is traditionally caused by gram-positive organisms, and delayed SSI is usually caused by low virulent skin flora. The preventative strategies of SSI after pediatric spine surgery include the application of best practice guideline （ BPG ）, antibiotic prophylaxis during the perioperative period and usage of vancomycin powder during the operation. The commonly used diagnostic methods include the related physical signs, such as high fever, and laboratory examinations. In the principle of treatment, acute deep SSI is typically treated with aggressive debridement, retention of implants and long- term antibiotic therapy. However, delayed SSI is usually treated with implant removal after that fusion mass has been confirmed. Up till now, long-term and high-quality studies are still needed to further evaluate the efficacy of infection prevention strategies and treatment tactics to reduce the rate of SSI after pediatric spine surgery.
作者
孙祥耀
海涌
SUN Xiang-yao HAI Yong.(Department of Orthopedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100020, China)
出处
《中国骨与关节杂志》
CAS
2017年第5期352-356,共5页
Chinese Journal of Bone and Joint
关键词
儿童
脊柱
外科手术
感染
Child
Spine
Surgical procedures, operative
Infection
