■近年来腰椎手术的数量有所增加。脊柱器械手术是脊柱病变治疗中不可或缺的组成部分,这可能导致手术部位感染(SSI)。手术部位感染(SSIs)是脊柱器械手术后死亡率和发病率的主要原因。SSI的管理是植入物的保留和移除仍不清楚。
■本文献的目的是系统地回顾用于脊柱器械手术后SSI管理的植入物移除和保留方法。
■我们在PubMed和ScienceDirect中搜索了英文队列和随机对照试验研究,发表于2002年至2022年之间,其中包含有关脊柱器械手术患者的数据。潜在的疾病,合并症,常见细菌,感染类型,感染的开始,移除植入物,分析保留百分比和推荐。使用纽卡斯尔-渥太华质量评估进行偏差分析。
■我们纳入了15项研究,总样本为2.584,平均年龄为15至66岁。检测到的最常见的生物是金黄色葡萄球菌,MRSA,和表皮。最常见的手术指征是退变性,其次是脊柱侧凸。种植体去除率和保留率分别为0-100%和0-90,32%。在脊柱器械手术后的患者中,植入物去除比植入物保留方法更常用。
■如果手术后<3个月,可以进行植入物保留。如果SSI的发生率>3个月,则建议移除植入物。经验性抗生素治疗是必要的,以减少清创术后移除植入物的可能性。进一步研究植入物的去除和保留对患者感染复发的影响,疼痛,需要患者的生活质量。
UNASSIGNED: The number of lumbar spine surgery increased in recent years. Spinal instrumentation surgery was an integral component in the treatment of spinal pathologies, which can cause surgical site infection (
SSI). Surgical site infections (SSIs) are the leading cause of mortality and morbidity after spinal instrumentation surgery. The management of
SSI was implant retention and removal is still unclear.
UNASSIGNED: The objective of this literature is to systematically
review the implant removal and retention method for
SSI management after spinal instrumentation surgery.
UNASSIGNED: We searched in PubMed and ScienceDirect for cohort and randomized control trial studies in English, published between 2002 and 2022, which had data on patients with spinal instrumentation surgery. The underlying disease, comorbidities, common bacteria, type of infection, the onset of infection, implant removal, and retention percentage and recommendation were analyzed. Bias analysis using Newcastle-Ottawa Quality Assessment.
UNASSIGNED: We included 15 studies with a total sample were 2.584 with an average of age 15 to 66 years old. The most common organism detected were S. Aureus, MRSA, and S. Epidermis. The most common surgical procedure indications were degenerative followed by scoliosis. Implant removal and retention rate were 0-100% and 0-90,32% respectively. Implant removal is more frequently used in patients after spinal instrumentation surgery than the implant retention method.
UNASSIGNED: Implant retention can be performed in case of SSI is < 3 months after surgery. Implant removal is recommended if the incidence of
SSI is > 3 months. Empirical antibiotics therapy is necessary to reduce the possibility of implant removal after debridement. Further studies on the effect of implant removal and retention in patients on infection recurrence, pain, and quality of life of patients are needed.