儿童脊柱术后手术区域感染的临床现状

孙祥耀; 海涌

doi:10.3969/j.issn.2095-252X.2017.05.007

摘要：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.