Clinical Application Of Improved VSD In The Treatment Of Infection After Thoracolumbar Posterior Internal Fixation

Research BackgroundInfection after posterior thoracolumbar internal fixation is a clinically common postoperative complication with serious consequences,which often brings huge pain and economic burden to patients.The use of metal implants makes postoperative infection curing more difficult.Studies have reported that traditional closed irrigation and drainage(CID)can cure postoperative infection by one-stage suture through continuous irrigation in the wound,but the drainage effect is poor,the infection control ability is not strong,and multiple debridement surgery is often required.Vacuum sealing drainage(VSD)has the characteristics of omnidirectional drainage,which can completely drain the contaminated tissue effusion in the wound,which has a good curative effect on postoperative infection.However,it cannot be sutured in the first stage,and the medical sponge in the device has a low life and often requires surgical replacement and multiple entry into the operating room lead to increased pain and economic loss for patients.To this end,we have improved the VSD technology and used it for clinical treatment of infection after posterior thoracolumbar internal fixation.ObjectiveTo analysis the therapeutic effect of improved VSD technique on patients with infection after posterior thoracolumbar internal fixation and discuss the clinical application value of improved VSD technique for treatment of deep incision infection after posterior thoracolumbar internal fixation when compared with traditional CID technique.Materials and MethodsA retrospective analysis of the medical records of 46 patients with early deep incision infection after posterior thoracolumbar internal fixation surgery in the Department of Orthopaedics,the First Affiliated Hospital of Zhengzhou University from February 2014 to February 2019,including 20 males and 26 females,there were 46 patients with an average age of 55.56± 10.31 years.They were divided into the improved VSD treatment group(24 cases)and the traditional CID treatment group(22 cases)due to different management.The basic data of the two groups,the results of bacterial culture,The lumbar spine ODI index and JOA score improvement at 6 months after surgery,wound healing situation,and implant retention were compared to evaluate the treatment effect of the two groups.The length of hospital stay,additional hospitalization costs,number of debridements were compared between the two groups.The number of occlusions and wound comorbidities were used to evaluate the advantages and disadvantages of the two methods and their clinical application value.Basic data,drainage tube occlusion rate,and short-term complications were compared between the two groups using χ2 test,continuity-corrected χ2 test or Fisher test was selected according to the amount of data.The mean length of stay was adjusted by Student t test,and the hospitalization cost and number of debridements were analyzed by the Mann-Whitney U test.The lumbar spine ODI index and JOA score improvement at 6 months after surgery were individually tested with a single sample t test,and the comparison between the two groups was performed using two independent sample t tests.We defined p<0.05 as statistically significant.ResultsForty-six patients in the two groups were discharged after one or more debridement surgery combined with one of the methods.The infection of all patients was controlled and cured,and all metal implants were retained,and no infection reappeared.There was no significant difference in general data between the two groups(p>0.05);Staphylococcus aureus is the most common infection strain.The difference in the number of debridement between the improved VSD group and the traditional CID group is statistically significant(p<0.05);The average number of days of hospitalization and the number of drainage tube blockages in the two groups are different statistical significant(p<0.05);There was no significant difference in the additional costs of infection treatment and short-term complications between the two groups(p>0.05);The lumbar spine ODI index and JOA score improvement before or at 6 months after surgery in the two groups were statistical significant(p<0.05);There was no significant difference in the improvement values of ODI and JOA before surgery or 6 months after surgery between the two groups(p>0.05).Conclusions1.For the treatment of deep incision infection after posterior thoracolumbar internal fixation,the improved VSD technology is equivalent to the traditional CID technology in cost and similar in efficacy,and both are cost-effective treatment methods.2.The improved VSD technology requires less debridement and shorter hospital stay than the traditional CID technology,and it is a better treatment option for deep infection of the incision after posterior thoracolumbar internal fixation.