脊柱手术部位感染课件

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1、脊柱手术部位感染俞武良2016-10-12手术部位感染(SurgicalsiteinfectionSSI)是一种相对常见的脊柱手术并发症，发生率为1%-14%，具有潜在的灾难性的后果。美国托马斯杰斐逊大学的Radcliff等筛选并总结了近5年成人脊柱手术后手术部位感染的发生率、危险因素、诊断、预防及治疗的相关研究，发表在2015年TheSpineJournal杂志。1、Incidenceaprospectivelycollecteddatabaseof108,419cases,theoverallinfectionrateforlumbarsurgerywas

2、2.1%(superficial=0.8%,deep=1.3%)TheincidenceofSSIappearstobelowerafterminimallyinvasivespinal(MIS)surgeriesAreviewof1,338MISsurgeriesfrommultipleinstitutionsrevealedaninfectionrateof0.74%infusion/fixationsand0.22%overallareviewbyParkeretalcomparedpostoperativeinfectionafteropenandmi

3、nimallyinvasivetransforaminallumbarinterbodyfusions.362MISand1,333opensurgeries，infectionrateof4%inopenspinalfusionsversus0.6%afterMIS(p=0.005)2、RiskfactorsforinfectionMedicalcomorbidities：anemia,diabetesmellitus,coronaryarterydisease,diagnosisofcoagulopathy,neoplasmobesityhigherAm

4、ericanSocietyofAnesthesiologistscoremalnutritiondiabetes,obesityhasbeenfoundtobeariskfactorforSSIskinfoldthicknessandL4spinousprocess-skinthicknessarespine-specificSSIriskfactorsindependentofbodymassindexthedistributionofadiposetissueandthedepthofadiposetissueoverlyingtheoperativef

5、ieldincreasedtheriskofSSItheparticulardiagnosisisaninfectionriskfactorpatientsundergoingsurgeryfordegenerativediseasehavealowerinfectionratecomparedtodeformity(1.4%vs.4.2%)Patientsundergoingsurgeryfortraumahaveahigherriskforinfectioncomparedtospinalfusion(9.4%vs.3.7%)theriskofinfect

6、ioniscorrelatedwiththeseverityofthetraumacaseordermaycontributetotherateofSSIafterspinesurgerylumbardecompressionperformedlaterintheday(thirdcase)ledtothreetimeshigherincidenceofSSIcomparedwiththoseperformedastheday’sfirstcasecontaminationoftheoperatingroom,cross-contaminationbetwe

7、enhealthcareprovidersduringthecourseoftheday,useofflashsterilization,andmid-dayshiftchanges.seasonaleffectontherateofpostoperativeeffectSSIincidencepeaksinthesummerandfallwithstatisticallysignificantdropsininfectionrateinthespringandwintercomplexproceduresmaypresentahigherriskofper

8、ioperativecomplicat