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논문 기본 정보

자료유형
학술저널
저자정보
이정수 (서울성심병원) 안동기 (서울성심병원) 장병권 (서울성심병원) 이재일 (서울성심병원)
저널정보
대한척추외과학회 Asian Spine Journal Asian Spine Journal Vol.9 No.6
발행연도
2015.1
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841 - 848 (8page)

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Study Design: A retrospective observational and case control study. Purpose: To identify appropriate treatment options according to the types of surgical site infections (SSI) in instrumented posterior lumbar interbody fusion (PLIF). Overview of Literature: There has been no agreement or consensus with regard to this matter. Methods: Thirty-two consecutive SSIs were included and followed for more than one year. The elapsed time to diagnosis (ETD) according to the type of SSI was analyzed. The treatment options for each type and consequent clinical results were reviewed. The risk factors of removing the implants were analyzed. Results: There were 6/32 (19%) superficial incisional, 6/32 (19%) deep incisional, and 20/32 (62%) organ/space infection cases (SII, DII, and O/SI, respectively) (p =0.002). ETD was 8.5±2.3 days in SII, 8.7±2.3 days in DII, and 164.5±131.1 days in O/SI (p =0.013). All cases of SII and DII retained implants and were treated by repeated irrigation and secondary closure. Among O/SIs, 10/20 were treated conservatively. Nine out of ten underwent posterior one stage simultaneous revision (POSSR) and in one case, the cage was removed anteriorly. Those who had ETDs longer than 3 months showed a significant risk of implant removal (p =0.008, odds ratio [OR]=40.3). The Oswestry disability index (ODI) improved from 47.3% to 33.8% in SII, from 55.0% to 32.3% in DII, and from 53.4% to 42.1% in O/SI (p =0.002). There was no difference among the three groups (p =0.106); however, there was a partial correlation between ETD and final ODI (r =0.382, p =0.034). Conclusions: Latent O/SI was the most common type of SSI in PLIF. In cases of SII and DII, early aggressive wound management and secondary closure was effective and implant removal was not necessary. In some cases of O/SI, implant removal was unavoidable. However, implant removal could be averted by an earlier diagnosis. POSSR was feasible and safe. Functional outcomes were improved; however, disability increased as ETD increased.

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참고문헌 (29)

참고문헌 신청
Liu X / 2014 / A systematic review with meta-analysis of posterior interbody fusion versus posterolateral fusion in lumbar spondylolisthesis / Eur Spine J 23:43~56 google schola Fritzell P / 2002 / Chronic low back pain and fusion: a comparison of three surgical techniques: a prospective multicenter randomized study from the Swedish lumbar spine study group / Spine (Phila Pa 1976) 27:1131~1141 google schola Christensen FB / 2002 / Circumferential lumbar spinal fusion with Brantigan cage versus posterolateral fusion with titanium Cotrel-Dubousset instrumentation: a prospective, randomized clinical study of 146 patients / Spine (Phila Pa 1976) 27:2674~2683 google schola Schofferman J / 2001 / A prospective randomized comparison of 270 degrees fusions to 360 degrees fusions (circumferential fusions) / Spine (Phila Pa 1976) 26:E207~E212 google schola Horan TC / 1992 / CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections / Am J Infect Control 20:271~274 google schola

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