Management of wound infection after lumbar arthrodesis maintaining the instrumentation

OBJECTIVE: To determinate whether a surgical protocol with immediate extensive debridement, closed irrigation system and antibiotic therapy would be effective to achieve healing of deep wound infection without removing the instrumentation.METHODS: Prospective cohort study with 19 patients presenting degenerative spinal stenosis or degenerative spondylolisthesis, who developed infection after posterior lumbar arthrodesis. The diagnosis was confirmed by a microbial culture from subfascial lumbar fluid and/or blood. Patients were treated with a protocol of wound exploration, extensive flushing and debridement, placement of a closed irrigation system that was maintained for five days and intravenous antibiotics. The instrumentation system was not removed.RESULTS: Mean age was 59.31 (±13.17) years old and most patients were female (94.7%; 18/19). The mean period for the identification of the infection was 2 weeks and 57.9% underwent a single wound exploration. White blood count, erythrocyte sedimentation rate and C-reactive protein showed a significant decrease post-treatment when compared to pre-treatment values. A significant reduction of erythrocyte sedimentation rate and C-reactive protein was also observed at the final evaluation. No laboratory test was useful to predict the need for more than one debridement.CONCLUSION: Patients with wound infection after instrumentation can be treated without removal of the instrumentation through wound exploration, extensive flushing, debridement of necrotic tissue, closed irrigation system during 5 days and proper antibiotic therapy. The blood tests were not useful to predict surgical re-interventions.

研究目的：探讨采用即刻广泛清创术、闭合冲洗系统联合抗生素治疗的手术方案，在不取出内固定器械（instrumentation）的前提下，实现深部伤口感染愈合的有效性。
研究方法：本研究为前瞻性队列研究，纳入19例腰椎后路融合术后出现感染的退行性腰椎管狭窄症或退行性腰椎滑脱症患者。诊断通过腰筋膜下积液和/或血液的微生物培养结果予以确认。所有患者均接受如下治疗方案：伤口探查、广泛冲洗与清创术，置入闭合冲洗系统并维持治疗5天，同时给予静脉抗生素治疗，且未取出内固定器械。
研究结果：患者平均年龄为59.31（±13.17）岁，其中女性占比94.7%（18/19），为绝大多数。感染确诊的平均间隔时间为2周，57.9%的患者仅接受单次伤口探查手术。与治疗前基线水平相比，患者的白细胞计数、红细胞沉降率及C反应蛋白水平在治疗后均出现显著下降；末次随访评估时，红细胞沉降率与C反应蛋白水平仍呈显著降低趋势。未发现任何实验室指标可预测患者是否需要接受多次清创手术。
研究结论：对于内固定术后出现伤口感染的患者，可通过伤口探查、广泛冲洗、坏死组织清创、5天闭合冲洗系统治疗及合理抗生素治疗，在不取出内固定器械的前提下实现感染愈合。血液实验室指标无法有效预测患者是否需要接受手术再次干预。