脊柱术后伤口感染.ppt

Locally traumatized areas should be allowed to heal before an incision is made JENNIFERB . MASSIE B, S Postoperative Posterior Spinal Wound Infections。Clinical Orthopaedics and Related Research 1992；284：99-108 抗生素 The role of prophylactic antibiotics in spinal surgery is well established 术前即刻应用抗生素 术后应用多长时间，决定于患者体质，手术时间，术中出血，固定节段等 Honvit7, N. H., and Curtin, J. A,: Prophylactic antibiotics and wound infections following laminectomy for lumbar disc herniation-a retrospective study. J. Neurosurg. 43:727. 1975. 抗生素的选择 个体化 二代头孢是经济的选择 如术前合并其他系统感染，应根据培养结果 术中伤口冲洗 a solution of povidone–iodine (PVP–I) and hydrogen peroxide (H2O2). reducing the rate of post-operative infection in spine surgery. 7/460 to 0/490 Simone Ulivieri Prevention of post-operative infections in spine surgery by wound irrigation with a solution of povidone–iodine and hydrogen peroxide Arch Orthop Trauma Surg 2011 ChengMT, ChangMC,Wang ST,YuWK, LiuCL, ChenTH(2005) Efficacy of dilute betadine solution irrigation in the prevention of postoperative infection of spinal surgery. Spine 30:1689–1693 治疗 怀疑伤口感染需要及时、积极、手术treatment of the suspected infection should be prompt, aggressive, and surgical 抗生素需要及时应用Antibiotic treatment is usually adjunctive and follows definitive surgical debridement Oxford Skeletal InfectionResearch and Intervention Service (OSIRIS) eight tissue samples taken from areas immediately adjacent to the instrumentation, along the length of the wound Six samples were sent for microbiology culture and microscopy and two were immediately fixed in formalin and sent for histological examination 发现感染 术中标本的采取 脊柱术后感染 早期外科手术包括切开、冲洗、清创术early surgical intervention with incision, irrigation, and debridement 特别是存在金属内固定、骨移植、硬膜暴露情况particularly in the presence of metallic implants, bone graft, and exposed dura, appear to exceed the risks of delay Michael T. Rohmiller, Closed Suction Irrigation for the Treatment of Postoperative Wound Infections Following Posterior Spinal Fusion