ABSTRACT
Objective:To investigate the incidence and management of deep surgical site infection(SSI) after the spinal deformity surgery.Methods:This study retrospectively reviewed a consecutive cohort of 8818 patients with spinal deformity who received spinal deformity surgery between January1998 and December 2017 at our center. The diagnosis of deep SSI was based on the clinical symptoms, imaging data and laboratory findings. Early infection and late infection were defined as deep infections occurring <3 months and >3 months after the initial procedure, respectively. All deep SSIs were first treated with irrigation and debridement, closed suction irrigation system and antibiotics. If the infection cannot be eradicated, dressing change is recommended within 2 years after the initial surgery. The instrumentation can be removed 2 years after the initial surgery with careful evaluation of the fusion mass. The posterior-anterior and lateral radiographs were used to measure the coronal parameters and sagittal alignment.Results:Sixty patients were diagnosed as deep SSI after spinal deformity surgery, including 11 patients with early infection and 49 patients with late infection. No significant difference was observed in terms of age, gender ratio, surgical approach and fusion levels between the two groups. Deep SSI seemed to be more likely to occur between 2 and 5 years after surgery. Incidence of SSI was lowest in the patients with idiopathic scoliosis and ankylosing spondylitis, and highest in the patients with neuromuscular and syndromic scoliosis. There was a high rate of negative culture in the primary culture. Staphylococcus aureus and Escherichia coli were the most common organisms in the early infection, while patients with late infection had a high rate of low-virulent skin flora. In the early infection group, nine patients retained instrumentation while the implants were removed 2 years after the primary surgery in 2 patients. In patients with late infection, instrumentation was retained in 5 cases and removed in 10 cases until 2 years after the primary surgery. 34 cases were infected 2 years after the primary surgery and the implants were removed directly. One patient underwent reoperation with instrumentation 1 month after implant removal, another patient underwent reoperation 3 years after implant removal due to progression of deformity. Significant loss of coronal correction was noted at the latest follow-up.Conclusion:The rate of deep SSI after spinal deformity surgery was 0.68%, of which the incidence of early infection and delayed infection was 0.12% and 0.56%, respectively. An increased risk of SSI in patients with neuromuscular and syndromic scoliosis was noted. If the infection cannot be eradicated after repeated debridement, we recommend instrumentation removal 2 years after the initial surgery, but there is still a high risk of loss of correction in these patients.
ABSTRACT
Objective To explore the effect of ginkgo biloba injection combined with alprostadil to hearing recovery,immunoglobulin level and hemorheology indexes of patients with sudden deafness.Methods 82 cases of sudden deafness patients collected in the first affiliated hospital of Wenzhou medical university from September 2015 to July 2014 were divided into control group(n=41) and experimental group(n=41) according to the random number table method.Control group were treated with 10μg alprostadil injection, added to 100 mL 0.9% saline infusion, intravenous drip, one time per day.Experimental group was given ginkgo biloba injection 20 mL, added to 500 mL 5% glucose intravenous drip on the basis of control group, one time per day.The clinical curative effect and hearing degree of recovery of two groups were observed after two weeks.Serum immunoglobulin A ( IgA ) , immunoglobulin G( IgG) , immunoglobulin M( IgM) levels were tested by automatic biochemical analyzer.The whole blood viscosity, plasma viscosity, red cell pressure product and red cell aggregation index were tested by blood viscosity analyzer.Results Two weeks after treatment, the total effective rate of experimental group was 92.68%, higher than 70.73% of the control group(χ2 =6.609,P=0.010).The tinnitus, aural fullness, vertigo and hearing recovery in experimental group was significantly higher than that of the control group, and the pure tone hearing threshold in experimental group was lower than the control group(P <0.05).After treatment, serum IgA, IgG and IgM levels were all decreased, and those indexes of experimental group were all significantly lower than those of control group(P<0.05).The whole blood viscosity, plasma viscosity, red blood cell hematocrit and red blood cell aggregation index were decreased, and those indexes of experimental group were all significantly lower than that of the control group( P <0.05).Conclusion The therapy of ginkgo biloba injection combined with alprostadil can reduce the tone of sudden deafness hearing threshold, promote the recovery of hearing, decreased in patients with immune globulin protein and hemorheology indexes, and improve clinical curative effect.