颈后路术中局部应用万古霉素对术后手术部位感染的影响

Outcomes of managing the surgical site infection with local vancomycin following posterior cervical surgery

目的：对比颈后路切口在术中是否局部应用万古霉素对术后切口愈合及感染的影响,探讨颈后路切口在术中局部应用万古霉素的优点。方法：前瞻性对照分析皖南医学院弋矶山医院脊柱外科2013年1月～2014年12月所选取的52个病例,分为A、B两组,其中男27人,女25人,平均年龄（52.25±11.00）岁,年龄32～68岁;术前、术后临床感染性指标变化的资料（体温、红细胞沉降率ESR、C-反应蛋白CRP、中性粒细胞比、淋巴细胞比）,其中脊髓型或神经根型颈椎病42人、颈部外伤致颈椎不稳9人、椎管内肿瘤1人,所选病例都接受颈后路手术并排除颈部感染性疾病。结果：52例手术均顺利完成,无手术或围手术期死亡病例,术后随访3个月。A、B两组术后第7天体温分别为（37.78±0.60）℃和（36.66±0.31）℃,P〈0.05;ESR分别为（31.00±8.49）mm/h和（14.19±1.30）mm/h,P〈0.05;CRP分别为（26.77±9.92）mg/L和（6.50±1.88）mg/L,P〈0.05;中性粒细胞比分别为（80.58±4.06）%和（56.92±3.11）%,P〈0.05;淋巴细胞比分别为（12.88±1.61）%和（23.08±3.77）%,P〈0.05。A、B两组间术前、术后第1天、术后第3天、术后第1个月、术后第3个月的体温、ESR、CRP、中性粒细胞比、淋巴细胞比均有统计学差异,P〈0.05。A组病例有9人在术后切口部位有轻微红肿发生并且A组病例平均住院天数比B组病例平均住院天数长5天。结论：颈后路手术切口在术中局部应用万古霉素可以有效地降低患者术后切口的感染率,减少患者的实际住院天数和医疗支出。

Objective：To observe the efficacy of managing the surgical site infection with local vancomycin following posterior cervical surgery.Methods：Retrospective analysis was performed in 52 cases undergone cervical surgery through posterior access in our hospital between January 2013 and December2014,with regard to the indicators suggestive of infections,including the temperature,erythrocyte sedimentation rate（ESR）,C-reaction protein（CRP）,neutrophil ratio and lymphocyte ratio,before and after surgery.Patients were allocated to group A（n = 27,male）and group B（n = 25,female）.The age of patients ranged from 32 to 68 years,with an average of 52.25 ± 11.00 years.In 52 cases,42 were associated with cervical spondylotic myelopathy or cervical spondylotic radiculopathy,9 with cervical instability due to neck trauma,and 1 with intraspinal tumor.Results：Operation was successful in the 52 cases,and no operative or perioperative death occurred.All patients were followed up for 3 months.At day 7 after operation,the temperature was（37.78 ±0.60）℃ and（36.66 ± 0.31）℃;ESR,（31.00 ± 8.49）mm/h and（14.19 ± 1.30）mm/h;CRP,（26.77 ± 9.92）mg/L and（6.50 ± 1.88）mg/L;the neutrophil ratio,（80.58 ± 4.06）% and（56.92 ± 3.11）%;the lymphocyte ration,（12.88 ± 1.61）% and（23.08 ± 3.77）%,respectively,for the group A and B（P 〈 0.05）.The difference was also significant between the two groups regarding the temperature,ESR,CRP,neutrophil ratio and lymphocyte ratio at day 1 and 3,in the first and third month after operation（P 〈 0.05）.Slight incision inflammation occurred in 9 cases in group A that had additional 5 days of hospital stay on average than group B.Conclusion：Local vancomycin may effectively reduce the incision infection for patients receiving cervical surgery by posterior access as well as hospital stay and medical costs.