Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery
Usefulness of white blood cell differential for early diagnosis of surgical wound infection following spinal instrumentation surgery
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DOI：
10.1097/01.brs.0000214895.67956.60
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发表时间：
2006-04-20
期刊：
影响因子：
3
通讯作者：
Kato, H
中科院分区：
文献类型：
--
作者：
Takahashi, J;Shono, Y;Kato, H
研究设计.对脊柱内固定手术后有或无手术伤口感染的患者进行前瞻性的白色血细胞（WBC）计数和WBC分类检测。探讨白细胞分类对脊柱内固定术后切口感染的早期诊断价值。背景数据总结。C-反应蛋白（CRP）或白细胞（WBC）的重新升高、镓扫描和CRP/甲状腺素运载蛋白质量浓度比值被报道用于外科伤口感染的早期诊断。本研究共入组了39例患者：13例患者在脊柱内固定手术后2周内发生伤口感染（感染组），26例患者在年龄、性别和所用手术技术方面与感染组患者相当（对照组）。分别于术前、术后测定外周血白细胞计数及分类。在两组中，白细胞和中性粒细胞百分比和数量显示几乎相同的变化，直到术后4天（第4天）。然而，在感染组中，这些参数在第4天后增加。在两组中，淋巴细胞的百分比和数量在第1天分别降至10%或更低和1，000/μ L或更低。这些淋巴细胞参数在第4天开始逐渐恢复正常，对照组在手术后3周恢复到术前水平。另一方面，在感染组中，这些参数保持在10%或更低和1，000/μ L或更低，直到第11天。感染患者淋巴细胞百分比和数量早在感染后第4天即明显下降。淋巴细胞减少症代表免疫抑制状态，因此表明对感染的易感性增加，这可能导致术后感染的发展。如果淋巴细胞减少症能尽早被诊断出来，手术伤口感染就能在不移除手术工具的情况下得到及时治疗。
Study Design. The white blood cell (WBC) count and WBC differential were measured prospectively in patients after spinal instrumentation surgery with or without surgical wound infection.Objectives. To investigate the usefulness of WBC differential for early diagnosis of surgical wound infection after spinal instrumentation surgery. Summary of Background Data. Renewed elevation of C-reactive protein (CRP) or WBC, gallium scan, and CRP/transthyretin mass concentration ratio were reported for early diagnosis of surgical wound infection.Methods. A total of 39 patients were enrolled in this study: 13 patients who developed wound infection within 2 weeks after spinal instrumentation surgery (infection group) and 26 patients who were comparable with those patients included in the infection group with regard to age, sex, and surgical techniques used (control group). The WBC count and WBC differential were determined before and after surgery.Results. In both groups, WBC and percentage and number of neutrophils showed nearly same change until postoperative 4 days (day 4). However, in the infection group, these parameters had increased after day 4. In both groups, the percentage and number of lymphocytes decreased to 10% or less and 1,000/mu L or less on day 1, respectively. These lymphocyte parameters began to gradually normalize on day 4 and returned to the preoperative level 3 weeks after surgery in the control group. On the other hand, these parameters remained 10% or less and 1,000/mu L or less until day 11 in the infection group. In patients with infection, the percentage and number of lymphocytes significantly decreased as early as on day 4.Conclusion. Lymphopenia represents immunodepression status, thus indicating the increased susceptibility to infection, which may lead to the development of postoperative infection. If lymphopenia is diagnosed as early as possible, surgical wound infection can be treated promptly without removing the instruments.