【摘要】 目的：评价局部应用不同剂量万古霉素预防腰椎融合术后手术部位感染（SSI）的疗效。方法：回顾性分析2019年3月至2022年8月行后路腰椎融合术的180例腰椎退行性疾病患者的临床资料。其中58例患者采用常规围手术期预防感染方案（常规组）；122例患者采用常规围手术期预防感染方案联合局部应用0.5 g万古霉素粉剂（0.5 g万古霉素组，62例）或1.0 g万古霉素粉剂（1.0 g万古霉素组，60例）。观察患者术后SSI情况，比较三组患者术后C反应蛋白（CRP）水平、红细胞沉降率（ESR）、疼痛视觉模拟评分（VAS）、腰椎日本骨科协会（JOA）评分，同时记录并发症发生情况。结果：1.0 g万古霉素组患者术后未发生SSI,0.5 g万古霉素组1例（1.6%）患者术后发生非葡萄球菌感染，常规组5例（8.6%）患者术后发生SSI，常规组与1.0 g万古霉素组SSI发生率差异有统计学意义（P<0.05）。术后1周，0.5 g和1.0 g万古霉素组患者CRP水平、ESR均低于常规组患者（P均<0.05），且1.0 g万古霉素组与0.5 g万古霉素组患者CRP水平、ESR差异均有统计学意义（P均<0.05）。术后1周、术后1个月0.5 g和1.0 g万古霉素组患者疼痛VAS评分均低于常规组患者（P均<0.05），腰椎JOA评分均高于常规组患者（P均<0.05）；万古霉素组无一例患者发生药物相关不良反应。结论：腰椎融合术中局部应用0.5 g、1.0 g万古霉素粉剂能够显著降低SSI发生率，局部应用1.0 g万古霉素能够更好地降低患者术后炎症水平，改善术后疗效。更多还原

【Abstract】 Objective: To evaluate the efficacy of local application of different doses of vancomycin for the prevention of surgical site infections(SSIs) after lumbar fusion surgery. Methods: Clinical data of 180 patients who underwent posterior lumbar fusion for lumbar degenerative disease from March 2019 to August 2022 were retrospectively analyzed. Fifty-eight patients received conventional perioperative infection prevention regimen(conventional group); 122 patients received conventional perioperative infection prevention regimen combined with local application of either 0.5 g vancomycin powder(0.5 g vancomycin group, 62 patients) or 1.0 g vancomycin powder(1.0 g vancomycin group, 60 patients). Postoperative C-reactive protein(CRP) levels, erythrocyte sedimentation rate(ESR),visual analogue score(VAS) for pain, and Japanese Orthopedic Association(JOA) scores for lumbar spine were compared among the three groups, and the occurrence of complications was also recorded. Results: No postoperative SSIs occurred in the 1.0 g vancomycin group, while one patient(1.6%) in the 0.5 g vancomycin group had a postoperative non-staphylococcal infection, and five patients(8.6%) in the conventional group developed postoperative SSIs, with a statistically significant difference in the incidence of SSIs between the conventional group and the 1.0 g vancomycin group(P<0.05). At 1 week postoperatively, patients in the 0.5 g or 1.0 g vancomycin group had lower CRP levels and ESR compared to those in the conventional group(both P<0.05), and the differences in CRP level and ESR between the 1.0 g vancomycin group and the 0.5 g vancomycin group were statistically significant(both P<0.05).At 1 week and 1 month postoperatively, patients in the 0.5 g or 1.0 g vancomycin group had lower VAS scores for pain and higher JOA scores compared to those in the conventional group(all P<0.05). None of the patients in the vancomycin group experienced drugrelated adverse reactions. Conclusions: Local application of 0.5 g or 1.0 g of vancomycin powder during lumbar fusion surgery can significantly reduce the incidence of SSIs. The local application of 1.0 g of vancomycin can better reduce the level of postoperative inflammation and improve postoperative outcomes in patients.更多还原