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Early Fu.ctional Ou.come of Posterior Spinal Decompression for Lu.bar Spinal Stenosis at a Tertiary Health Institu.ion, Sou.h East Nigeria

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Jou.nal of Biosciences and Medicines 2018年第7期6卷 1-14页

作者： obiora nonso mu.ghalu.cajetan u. nwadinigwe Emmanu.l C. Iyidobi Ndu.u.si N. Du.u.u.o E. Anyaehie Ikechu.wu.C. Okwesili Department of Orthopaedics National Orthopaedic Hospital Enugu Nigeria

Backgrou.d: Su.gical treatment of lu.bar spinal stenosis by posterior spinal decompression may be indicated if non-su.gical management for the symptoms of low back and lower limbs radicu.ar pains is u.su.cessfu. and/or in patients with persisting or worsening neu.ological deficits. It has been reported to be an effective treatment modality in well selected patients. This procedu.e is however not withou. possible complications which can adversely affect the ou.come of treatment in the affected patients. This prospective stu.y was therefore u.dertaken to evalu.te the early fu.ctional ou.come of posterior spinal decompression for lu.bar spinal stenosis at ou. health institu.ion. Method: All patients with symptomatic lu.bar spinal stenosis admitted for posterior spinal decompression and who met the inclu.ion criteria were recru.ted with their written informed consent. The patients’ pain severity and fu.ctional disability were assessed preoperatively with visu.l analogu. scale (VAS) and Oswestry Disability Index (ODI). The VAS and ODI were also u.ed to reassess the patients postoperatively, at 2 weeks, 6 weeks and 12 weeks respectively. All intraoperative and/or postoperative complications were docu.ented and the resu.ts were analyzed. Resu.ts: The patients’ mean preoperative lower back pain and leg pain VAS score was 8.26 ± 1.46 while the mean preoperative ODI was 62.4% ±13.56. The commonest combination of spinal decompressive procedu.e done in the patients was laminectomy + foraminotomy in 10 (25% patients). The most common decompressed spinal level was L4/L5 (89.7%);while almost equ.l nu.ber of patients had either one spinal level or two-spinal level decompression (43.6% and 46.1% respectively). Postoperative pain assessment showed a mean VAS of 3.79 ± 1.15, 2.55 ± 1.27 and 2.00 ± 1.41 at 2 weeks, 6 weeks and 12 weeks respectively (p = 0.000). Fu.ctional ou.come assessment with ODI was 34% ± 11.79%, 24% ± 10.75% and 18.12% ± 10.61% at 2 weeks, 6 weeks and 12 weeks res

关键词： Early Fu.ctional Ou.come Lu.bar Spinal Stenosis Posterior Spinal

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The Bacteriological Profile of Su.gical Site Infections in Orthopaedic Implant Su.geries in Sou.h-East Nigeria

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Jou.nal of Biosciences and Medicines 2019年第9期7卷 19-27页

作者： Kelechu.wu.A. Okoro Osita Ede Emmanu.l C. Iyidobi u.ochu.wu.u. Enweani cajetan u. nwadinigwe Gabriel O. Eyichu.wu.u.o E. Anyaehie Francis N. Ahaotu.Richard C. Ezeh Department of Orthopaedics and Trau.a National Orthopaedic Hospital Enugu Nigeria City Clinics Enugu Nigeria

Backgrou.d: Knowledge of the common bacteria that cau.e su.gical site infection (SSI) and their antibiotic sensitivity is mandatory if treatment of su.gical infection is to be su.cessfu.. The threat of the emergence of resistant strains of bacteria is ever-present. Hence, a sensitivity directed therapy is paramou.t for the su.cessfu. eradication of organisms with minimal risk of development of antibiotic resistance. Aim: The aim is to identify the common bacteria that cau.e SSI in orthopaedic implant su.geries in ou. hospital. Method: This is a prospective longitu.inal stu.y that inclu.es all orthopaedic su.geries involving the u.e of implants within one year. Patients that had major orthopaedic su.geries involving implant were followed u. and their wou.ds inspected for signs of SSI on postoperative days 3, 7, 14, 42 and 90. Wou.d swab was taken for microscopy, cu.tu.e and sensitivity analysis from those who had wou.d infection, based on the CDC gu.delines. Resu.ts: One-hu.dred and sixteen patients met ou. inclu.ion criteria and were inclu.ed in the analysis. There were 62 males and 54 females. The mean age of the participant was 39.62 years (SD = 15.02 years). Fractu.e fixation with plates and screws was the most common implant su.gery done. The incidence of SSI was 2.6%, and Escherichia coli was the most common isolated pathogen. All the SSIs were su.erficial incisional type, and the infection was monomicrobial in 67% of cases and polymicrobial in 33%. All of the isolated pathogens were sensitive to Imipenem and Gentamycin. Conclu.ion: Su.erficial incisional SSI is the most common type of SSI in this stu.y. Escherichia coli is the most frequ.nt pathogen in SSI affecting implant su.geries in ou. hospital. Gentamycin and Imipenem shou.d be u.ed for the prophylaxis of SSI in ou. environment.

关键词： SSI Bacteriology Orthopaedic Implant Nigeria

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The Antiseptic Efficacy of Povidone-Iodine in Redu.ing Early Su.gical Site Infections in Orthopaedic Implant Su.geries

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Jou.nal of Biosciences and Medicines 2019年第9期7卷 9-18页

作者： Kelechu.wu.A. Okoro Osita Ede u.ochu.wu.u. Enweani Emmanu.l C. Iyidobi cajetan u. nwadinigwe Gabriel O. Eyichu.wu.u.o E. Anyaehie Francis N. Ahaotu.Richard C. Ezeh Department of Orthopaedics and Trau.a National Orthopaedic Hospital Enugu Nigeria City Clinics Enugu Nigeria

Backgrou.d: Su.gical site infection (SSI) is a dreaded nightmare for the Orthopaedic su.geon. Preoperative skin cleaning with antiseptics has been shown to redu.e the microbial bu.den of the skin and resu.ts in redu.ed incidence of SSI. However, the ideal skin cleaning agent remains to be established. Aim: To compare the efficacy of Povidone-Iodine/Povidone-Iodine (PI-PI) combination with that of Chlorhexidine-Glu.onate/Alcohol (CG-A) combination in re-du.ing SSI in Orthopaedic su.geries. Methods: This was a prospective, randomized, dou.le-blinded, controlled stu.y. Su.jects that met the selection criteria and gave consent were randomized into PI-PI grou. (test grou.) and the CG-A grou. (control grou.). Both the patients and the assessors for SSI were blinded to the grou. a participant belongs. Blocking was done on the type of su.gery to cancel the confou.ding effect of su.gery type on SSI. Standard perioperative protocols were applied to both grou.s. Assessment for featu.es of SSI was done on the 3rd day, 7th day, 14th day, 6th week and 12th-week postoperative period. The diagnosis of SSI was made based on the Centers for Disease and Control (CDC) gu.delines. Resu.ts: We recru.ted 124 patients for this stu.y, 62 males and 54 females. The mean age of the su.jects was 37.5 years (SD = 14.7 years). Sixty-two su.jects were randomized into each grou.. There was no significant difference in the distribu.ion of the genders in the stu.y arms. Other possible confou.ders su.h as du.ation of hospital stay, u.e of drains, the su.geon involved and age were evenly distribu.ed in the two grou.s. Eight patients did not complete the stu.y. The overall incidence of SSI in the stu.y was 2.6%. Su.jects in the control grou. had an SSI of 3.4% while those in the PI-PI grou. had a rate of 1.8%;however, this was not significant, p = 0.579. Conclu.ion: Both CG-A and PI-PI combinations are equ.lly efficaciou. as preoperative skin antiseptic in Orthopaedic implant su.geries.

关键词： SSI Orthopaedic Implant Su.geries Chlorhexidine Glu.onate-Alcohol Povidone Iodine

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