An empiric analysis of 5 counter measures against surgical site infections following spine surgery—a pragmatic approach and review of the literature

BACKGROUND CONTEXT

Surgical site infections (SSI) following spine surgery are debilitating complications to patients and costly to the healthcare system.

Efficacy of nasal irrigation with hypertonic saline on chronic rhinosinusitis: systematic review and meta-analysis

IntroductionCurrently, several different concentrations of saline are recommended for use in nasal irrigation. Increasing studies show that nasal irrigation with hypertonic saline is more effective than traditional saline in the treatment of rhinosinusitis, but there have been few systematic analyses of the effect of nasal irrigation with hypertonic saline on chronic rhinosinusitis.ObjectiveWe sought to compare the effects of hypertonic saline and isotonic saline in the treatment of rhinosinusitis in order to provide a reference for clinical nasal irrigation for chronic rhinosinusitis treatment.MethodsMedline, cochrane library, EMBASE, PubMed, Chinese biomedical journal database, China national knowledge infrastructure, Wanfang database, and other databases were searched, and the searching was supplemented by manual searches for relevant references to treatment of rhinosinusitis by saline nasal irrigation. The last retrieval date was March 2018. The included studies were evaluated for quality, and data were extracted for meta-analysis using RevMan 5.3.ResultsSeven studies were included. Effects favoring hypertonic saline on nasal symptoms were greater in 4 subgroups. These were (1) patients with nasal secretion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (2) patients with congestion (SMD = 1.52; 95% CI: 1.04, 2.00; p < 0.01), (3) patients with headache (SMD = 0.82; 95% CI: 0.38, 1.26; p < 0.01), (4) patients with overall symptomatic relief (SMD = 1.63; 95% CI: 0.83, 2.44; p < 0.01). However, no difference was shown in smell improvement (SMD = 0.47; 95% CI: −0.65, 1.59; p = 0.41) and radiologic scores improvement (SMD = 2.44; 95% CI: -3.14, 8.02; p < 0.01). Besides, hypertonic saline showed greater improvement in mucociliary clearance time scores than did the isotonic saline group (SMD = 1.19; 95% CI: 0.78, 1.60; p < 0.01). Hypertonic saline brought greater minor adverse effects.ConclusionCompared with isotonic saline, hypertonic saline nasal irrigation for the treatment of chronic rhinosinusitis is significantly more effective and has mild side effects in improving nasal symptoms and ciliary movement, but there is no significant difference in imaging findings and smell improvement. Although hypertonic saline is worthy of widespread use in clinical practice, it is still necessary to further study the exact manner and concentration of nasal irrigation.     

跟骨骨折内固定术后慢性跟骨骨髓炎的治疗

目的探讨跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损的治疗方法及疗效评估。方法1999年2月～2005年6月收治跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损17例患者采用清除病灶,根据死腔部位及大小选择设计不同的带血管蒂肌皮瓣或皮瓣填充覆盖,一期消灭死腔,改善局部血运,覆盖创面,并于皮瓣覆盖的上、下部分别将冲洗及引流管置入原死腔部位进行持续冲洗治疗。结果全部患者获得3个月～3年(平均25个月)的随访,术后移植组织全部成活,骨髓炎无复发,足跟部皮瓣外形良好,13例感觉恢复好,耐磨擦能力尚可,能够负重。结论组织移植并持续冲洗的治疗方法具有手术操作简单、供区损伤小、成功率高和疗效好等优点,是治疗跟骨骨折内固定术后慢性跟骨骨髓炎伴溃疡或皮肤缺损的理想方法。     

Biomechanical evaluation of a new augmentation method for enhanced screw fixation in osteoporotic proximal femoral fractures.

A biomechanical investigation on eight pairs of human cadaver proximal femurs was performed to evaluate the impact of a new augmentation method on the internal fixation of osteoporotic proximal femur fractures. The study focused on enhancing implant purchase to reduce the incidence of implant cut-out in osteoporotic bone. In a left-right comparison, a conventional hip screw fixation (control) was compared to the new cement augmentation method. After bone bed preparation through high pressure irrigation to remove fat, blood, and bone debris, the bones were augmented with low viscosity polymethylmethacrylate (PMMA) cement. Step-wise fatigue testing was performed by cyclically loading the femoral heads in a physiological manner, beginning at 1,500 N and increasing 500 N every 5,000 cycles to 4,000 N, and continuously monitoring head displacement. Failure was defined as >5.0 mm head displacement. The head displacement at 2,000 N was significantly smaller (p=0.018) for the augmented group as compared to the conventionally treated bones (0.09+/-0.01 mm vs. 0.90+/-0.32 mm; mean+/-SEM). The displacement rate at the second load step was significantly higher (p=0.018) for the conventionally treated bones as compared to the augmented ones. All of the nonaugmented specimens failed during testing, where 50% of the augmented specimens did not fail. The promising results of these experiments suggest that this new standardized irrigation/augmentation method enhances the implant anchorage and offers a potential solution to the problem of implant cut-out in osteoporotic metaphyseal bone.     

综合护理在皮肤软组织缺损患者中的应用效果

探讨在应用封闭式负压引流（VSD）联合持续冲洗治疗皮肤软组织缺损的护理中实施综 合护理的效果。方法 选取2021年11月-2023年4月我院收治的62例皮肤软组织缺损患者为研究对象，均为 一期应用VSD联合生理盐水持续冲洗辅助治疗创面，待新鲜肉芽生长满意后二期植皮、换药等治疗。随机 分为对照组和观察组，各31例。对照组实施常规护理，观察组实施综合护理，比较两组疾病康复时间、 护理效果、不良反应发生情况、疼痛程度及护理满意度。结果 观察组新生肉芽组织生长满意时间、住 院时间均短于对照组，总有效率高于对照组，轻度疼痛度占比高于对照组，不良反应发生率低于对照组 （P ＜0.05）；两组护理满意度比较，差异无统计学意义（P ＞0.05）。结论 综合护理在接受VSD联合持续 冲洗治疗的皮肤软组织缺损患者中的应用效果确切，可有效缩短新鲜肉芽生长满意时间、住院时间，降低 不良反应发生率，且减轻患者疼痛程度，提升患者对护理的满意度。     

外固定器结合闭式灌洗治疗下肢长骨骨折术后感染

目的 观察外固定器结合闭式灌洗治疗下肢长骨骨折切开复位钢板内固定术后感染的临床疗效。方法 采用组合式外固定器结合病灶清除术及术后持续闭式灌洗治疗下肢长骨骨折切开复位钢板内固定术后感染患者32例。结果 经1．5～3年随访，31例感染未再复发，26例在半年内骨折愈合，无1例出现骨折短缩、成角等畸形愈合和严重关节僵硬并发症。结论 外固定器结合闭式灌洗是治疗下肢长骨骨折切开复位钢板内固定术后感染的有效方法。     

Surgical decompression: a life-saving procedure for an extensive spinal epidural abscess

Extensive spinal epidural abscesses (SEAs) carry a high mortality rate. Traditionally they are treated non-operatively with longterm antibiotics and/or surgical decompression, but there is a continuing debate as to whether they should be managed by emergency surgical decompression. However, such decisions are made in the light of the clinical setting. We report the successful management of a female patient who presented with features of upper cervical cord compression and later developed septic shock and multisystem failure. Surgical decompression of the cervical spine and irrigation of the epidural space with a paediatric catheter was performed followed by tricortical strut grafting and plating. At review, 36 weeks after surgery, the patient remained asymptomatic, having made full neurological recovery. The purpose of this report is to highlight the importance of emergency surgical intervention for extensive SEA in the presence of progressive neurological loss associated with multisystem failure.     

Retrograde commercial colonic hydrotherapy

OBJECTIVE: To ascertain the current practice of commercial colonic hydrotherapy in the UK and to collect data on the profiles of both the practitioners and their clients. In addition to understand how colonic hydrotherapy is perceived by those who use it and how much economic benefit it generates for the practitioners. Information as to training and complications was sought. PATIENTS AND METHODS: A questionnaire was sent to all 80 practitioners registered with the Association of Colonic Hydrotherapists (ACH) of the UK. The practitioners who responded were sent 10 questionnaires to be given to a group of consecutive clients. This client questionnaire included an SF-36 self-administered scoring system and a satisfaction survey. To understand the methodology and ritual of the hydrotherapy procedure a field trip was arranged and two of the authors (NJT and PJM) underwent one colonic hydrotherapy session with an experience practitioner. RESULTS: Thirty-eight (48%) of practitioners responded to our practitioner survey and 242 client questionnaires were returned. One third of practitioners reported a previous clinical background and 32 (83%) were single-handed practitioners. The average time in practice was six years and with an average age of the hydrotherapists being 50 years (22-78 years). Estimated number of sessions conducted were 3200 (range 140-10 000). Average annual income before expenses per practitioner was estimated at pound 45 675. The clients' ages ranged was 18 and 82 years of age (mean 44 years) and had undergone an average of 35 hydrotherapy treatments (range 1-2500). Clients had lower SF-36 scores than the UK norm. CONCLUSION: Colonic hydrotherapy is practised widely in the UK with an estimated 5600 procedures carried out by ACH practitioners monthly. It is not known how much activity is carried out by non-ACH members. ACH practitioners appear to be well trained and a proportion have medical backgrounds. Clients, who are often unhappy with orthodox medicine seem satisfied enough with the experience of colonic hydrotherapy to undergo regular purgings. No serious side-effects have been reported to us. Economic factors could be a driving force for the continuation of the practice as the monies earnt are not inconsiderable.     

Wound Irrigation with Tap Water

Abstract. Objective: The study hypothesis was that irrigation with tap water is as efficacious as irrigation with sterile saline in removing bacteria from simple lacerations in preparation for wound closure.
Methods: The study was conducted in a laboratory rat model previously described in the literature for evaluating wound irrigation techniques. The study used a randomized, blinded crossover design using 10 animals. Two full-thickness skin lacerations were made on each animal and each wound was inoculated with standardized concentrations of a Staphylococcus aureus broth. Wounds were irrigated for 4 minutes with normal saline from a syringe or 4 minutes with tap water from a faucet. Tissue specimens were sampled from each laceration prior to and following irrigation. Bacterial counts per gram of tissue were determined for each specimen and compared pre- and postirrigation.
Results: Preirrigation bacterial counts were not significantly different for saline vs tap water specimens. The wounds irrigated with saline had a mean reduction in bacterial count of 54.7% (SD =±28%), while the wounds irrigated with tap water had a mean reduction in bacterial count of 80.6% (SD =±20%) (p < 0.05, 2-tailed, paired t-test).
Conclusions: In this animal model, bacterial decontamination of simple lacerations was not compromised, and was actually improved using tap water irrigation. This is most likely due to the mechanical differences in the types of irrigation. In certain instances, such as with upper-extremity lacerations, tap water irrigation would likely be cheaper and less labor-intensive than irrigation with normal saline from a syringe.