脊柱手术中预防性使用万古霉素粉末对术后感染影响的Meta分析研究

Effect of Intra-Wound Vancomycin Application in Spinal Surgery on the Incidence of Postoperative Surgical Site Infection—A Meta-Analysis

摘要: 目的：通过查阅预防性使用万古霉素粉末手术比较的文献，对该方法在脊柱手术后降低感染率的效果做出系统评价，为以后的临床工作提供依据。方法：通过Pubmed，Medline，Elseveir，万方，CNKI等数据库，以“vancomycin”，“local/intraoperative/topical/intra-wound”，“spine/spinal/lumbar/cervical/thoracolumbar surgery”，“infection”，“SSI”，“脊柱”，“腰椎”，“颈椎”，“手术”，“万古霉素”，“感染”等关键词查找相关术中预防性应用万古霉素粉末对术后感染发生率影响方面的病例对照研究论文，并利用Revman5.3荟萃分析软件比较文献中总体感染率，并按不同亚组分析是否应用万古霉素对不同部位、不同类型的脊柱手术的感染率的影响。结果：共查出论文1713篇，其中病例对照试验有38篇，最后筛选出符合要求的文献25篇；有25个研究比较了预防性使用万古霉素粉末对脊柱手术后感染率的影响。总病例16,688例，其中预防性使用万古霉素组7048例，对照组9640例。其荟萃分析结果提示术中预防性使用万古霉素粉末后术后出现感染的可能性为不使用万古霉素时的0.38倍，二者之间的差异有显著性(P < 0.01)。同时，在使用内固定的患者中，使用万古霉素后感染发生率是不使用万古霉素时的0.28倍(0.17, 0.45)，二者之间有显著性差异(P < 0.01)。但是，在没有内固定的患者中利用万古霉素对术后感染并没有显著影响(P = 0.61)。结论：脊柱手术中局部预防性使用万古霉素粉末能明显减少术后感染的发生率，而这种效果在使用内固定的患者中更为明显，可在脊柱外科临床实践中推广应用。

Abstract: Objective: To systematically evaluate the effect of this method in reducing the infection rate after spinal surgery by reviewing the comparative literature of prophylactic vancomycin powder surgery, so as to provide a basis for future clinical work. Methods: Pubmed, Medline, Elseveir, Wanfang, CNKI and other databases, with the following methods: “vancomycin”, “local/intraoperative/topical/intra-wound”, “spine/spinal/lumbar/cervical/thoracolumbar surgery”, “infection”, “SSI”, “spine”, “lumbar spine”, “cervical spine”, “surgery”, “vancomycin”, “infection” and other keywords were used to find case-control research papers on the effect of intraoperative prophylactic vancomycin powder on the incidence of postoperative infection, and the Revman5.3 meta-analysis software was used to compare the overall infection rate in the literature, and the effect of vancomycin application on the infection rate of different parts and different types of spine surgery was analyzed according to different subgroups. Results: A total of 1713 papers were identified, including 38 case-control trials, and 25 papers were screened to meet the requirements. Twenty-five studies compared the effect of prophylactic use of vancomycin powder on infection rates after spinal surgery. The total number of cases was 16,688, including 7048 cases in the prophylactic vancomycin group and 9640 cases in the control group. The results of meta-analysis showed that the probability of postoperative infection after intraoperative prophylactic use of vancomycin powder was 0.38 times higher than that of vancomycin without vancomycin, and the difference between the two was significant (P < 0.01). At the same time, the incidence of infection after vancomycin was 0.28 times higher (0.17, 0.45) than that of vancomycin in patients treated with internal fixation (P < 0.01). However, vancomycin utilization in patients without internal fixation had no significant effect on postoperative infection (P = 0.61). Conclusion: The local prophylactic use of vancomycin powder in spine surgery can significantly reduce the incidence of postoperative infection, and this effect is more obvious in patients with internal fixation, which can be popularized and applied in clinical practice of spine surgery.