抗生素骨水泥剂量差异对行关节置换术患者康复效果及再发感染风险的影响

Study on the effect of different dosages of antibiotic bone cement on rehabilitation and risk of recurrent infection in patients undergoing joint replacement

目的探讨抗生素骨水泥剂量差异对行关节置换术患者康复效果及再发感染风险的影响。方法前瞻性研究,选取2015年1月至2017年6月在上海市浦东新区公利医院接受全膝关节置换术的患者76例。采用随机数字表法将患者分为低剂量组(n=38)和高剂量组(n=38),低剂量组将40 g常规骨水泥与1 g万古霉素搅拌均匀加入骨水泥单体,高剂量组将40 g常规骨水泥与2 g万古霉素搅拌均匀加入骨水泥单体。选择同期在上海市浦东新区公利医院接受传统不含有抗生素的常规骨水泥作为间隔体的行全膝关节置换术的38例患者作为对照组。比较三组患者的术后康复效果、感染情况、血清学指标和Lysholm-Tenger膝关节运动水平评分。结果低剂量组和高剂量组患者的术后屈膝角度分别为(122. 39±15. 17)°和(122. 63±15. 09)°,大于对照组,术后卧床时间分别为(5. 95±0. 84) d和(5. 91±0. 82) d,短于对照组,差异均具有统计学意义(P <0. 05),但低剂量组和高剂量组患者比较差异无统计学意义(P>0. 05)。对照组患者术后出现1例感染,其余两组未出现感染病例。三组患者治疗前C反应蛋白和红细胞沉降率水平相近(P> 0. 05)。治疗7 d后,低剂量组和高剂量组患者的C反应蛋白和红细胞沉降率水平低于对照组,差异具有统计学意义(P <0. 05),但低剂量组和高剂量组患者比较差异无统计学意义(P> 0. 05)。治疗6个月后,低剂量组和高剂量组患者的Lysholm评分分别为(73. 25±9. 39)分和(73. 41±9. 35)分,Tenger评分分别为(5. 57±0. 83)分和(5. 61±0. 79)分,均高于对照组,差异具有统计学意义(P <0. 05),但低剂量组和高剂量组患者比较差异无统计学意义(P>0. 05)。结论含抗生素骨水泥作为间隔体行全膝关节置换术可以降低患者的炎症水平,有助于控制术后感染,促进膝关节功能康复,但1 g万古霉素骨水泥和2 g万古霉素骨水泥对行全膝关节置换术患者效果相近。

Objective To explore the effect of different dosages of antibiotic bone cement on rehabilitation and risk of recurrent infection in patients undergoing joint replacement. Methods This is a prospective study,a total of 76 patients undergoing total knee arthroplasty in this hospital during January 2015 to June 2017 were selected for this study. They were divided into low dosage group( n = 38) and high dosage group( n = 38) by using random number table method. In low dosage group,40 g cement and 1 g Vancomycin were evenly mixed into the bone cement monomer,and in high dosage group 40 g conventional bone cement mixed with 2 g Vancomycin to add into the bone cement monomer. A total of38 patients undergoing total knee arthroplasty in this hospital received conventional bone cement without antibiotic in the same period were selected as control group. The postoperative rehabilitation effect,infection rate,serological indices and Lysholm-Tenger knee motion level scores were compared between these three groups. Results The angles of knee flexion in low dosage group and high dosage group were( 122. 39 ± 15. 17) °and( 122. 63 ± 15. 09) °respectively,bigger than those of control group,and the time for rest of these patients were( 5. 95 ± 0. 84) d and( 5. 91± 0. 82) d respectively,shorter than those of control group. The difference was statistically significant( P < 0. 05),but there was no significant difference between low dosage group and high dosage group( P > 0. 05). There was 1 case in control group had infection after operation and other two groups had no case with infection.. The level of C-reactive protein and erythrocyte sedimentation rate in these three groups were similar( P> 0. 05). The level of C-reactive protein and erythrocyte sedimentation rate in low dosage group and high dosage group after treatment were lower than those of control group( P < 0. 05),but the difference was not statistically significant in the low dosage group and the high dosage group ( P > 0. 05). In 6 months after treatment,the Lysholm scores in low dosage group and high dosage group were( 73. 25 ± 9. 39) scores and( 73.41 ± 9. 35) scores respectively,and the Tenger scores were( 5. 57 ± 0. 83) scores and( 5. 61 ± 0. 79) scores respectively,they were higher than those of control group,and the difference was statistically significant( P < 0. 05),but there was no significant difference between low dosage group and high dosage group( P > 0. 05). Conclusion Total knee replacement with antibiotic bone cement can reduce the level of inflammation in patients,help to control postoperative infection and promote the rehabilitation of function of knee joint,but 1 g vancomycin bone cement and 2 G vancomycin cement have similar effect in patients undergoing total knee arthroplasty.