局部应用万古霉素粉剂在初次全膝关节置换术中的疗效分析

Effectiveness analysis of the local application of vancomycin powder in primary total knee arthroplasties

目的感染是全膝关节置换最常见的并发症之一,而局部应用万古霉素能否降低感染的发生率尚不明确,本文拟研究在初次全膝关节置换术中局部关节腔内应用万古霉素的有效性,为临床治疗提供一定理论依据。方法收集2014年6月-2018年6月蚌埠医学院第一附属医院骨科收治的290例终末期膝关节骨性关节炎行单侧全膝关节置换患者的临床资料。根据术中缝合关节囊前是否使用万古霉素粉剂(vancomycin powder,VP),分为VP组(178例)和对照组(112例)。VP组在缝合关节囊前将1 g万古霉素粉剂撒入关节腔内。2组患者性别、年龄、体质量指数、血红蛋白含量、血清白蛋白、术前合并症等一般资料比较,差异均无统计学意义(P>0.05)。记录2组手术时间、术后血红蛋白、术后白蛋白水平,切口无菌性渗出、皮下血肿、延迟愈合、皮肤坏死、假体周围感染、下肢深静脉血栓、肺栓塞的发生例数,采用SPSS 22.0统计学软件进行统计分析。结果 VP组有5例(2.81%)、对照组有3例(2.68%)发生假体周围感染(PJI),2组患者PJI发生率无统计学差异(χ^2=0.066,P=0.947)。VP组切口无菌性渗出的发生率为6.18%(11/178)、对照组为3.57%(4/112),2组比较差异无统计学意义(χ^2=0.977,P=0.329),VP组切口延迟愈合发生率为8.99%(16/178)、对照组为2.68%(3/112),VP组患者切口延迟愈合发生率明显高于对照组,差异有统计学意义(χ^2=2.114,P=0.035)。2组患者皮肤浅表感染、皮肤坏死、深静脉血栓、肺栓塞发生率比较差异无统计学意义(均P>0.05)。结论初次全膝关节置换局部应用万古霉素粉剂并不能降低假体周围感染发生率,相反会增加切口无菌性并发症的发生率,因此不推荐在初次全膝关节置换术中常规局部应用万古霉素。

Objective To investigate the effectiveness of vancomycin powder(VP) in the local joint in primary total knee arthroplasties(TKA), and provide a theoretical basis for clinical treatment. Methods A total of 290 patients diagnosed as end-stage knee osteoarthritis who underwent primary unilateral TKA between June 2014 and June 2018 were randomly divided into VP group(n=178) and control group(n=112) based on whether use high-dose VP before the capsule suture. In the VP group, 1 g of vancomycin was used in the powder state without solution. There were no significant difference in sex, age, body mass index, hemoglobin content, serum albumin and preoperative complications between the two groups(P>0.05). The operation time, hemoglobin and albumin levels, aseptic exudation of incision, subcutaneous hematoma, delayed healing, skin necrosis, prosthetic joint infection(PJI), deep venous thrombosis of lower limbs, pulmonary embolism and acute renal injury were recorded. Results There was no statistical difference in PJI rates between VP group(2.81%) and control group(2.68%), χ^2=0.066, P=0.947. There was no statistical difference in aseptic exudation of incision between VP group(6.18%) and control group(3.57%), χ^2=0.977, P=0.329. The rate of prolonged operative wound healing in VP group(8.99%) was higher than that in control group(2.68%), χ^2=2.114, P=0.035. There was no significant difference in the incidence of superficial skin infection, skin necrosis, deep vein thrombosis and pulmonary embolism between the two groups(all P>0.05). Conclusion Local application of VP in primary TKA cannot reduce the incidence of PJI, but increase the incidence of aseptic complications of incision, so it is not recommended to use vancomycin in the primary TKA.