人工关节置换术中碘伏处理创口对预防假体周围感染的临床效果评价

Evaluation of the Clinical Effect of Iodophor Treatment on the Prevention of Periprosthetic Infection in Artificial Joint Replacement

目的:研究在初次全髋和膝关节置换术中切口内碘伏浸泡预防假体周围感染(PJI)的临床效果。方法:回顾性分析2014年11月-2018年1月在笔者所在医院行初次全髋和膝关节置换术的293例患者的临床资料。从2016年2月开始,所有关节置换术中均使用碘伏浸泡、冲洗,对照组(2014年11月-2016年1月,n=102)在安放假体前后及关闭切口前使用1 L生理盐水冲洗术野,碘伏组(2016年2月-2018年1月,n=191)在安放假体前后及关闭切口前使用0.5%碘伏溶液浸泡术野2 min后用1 L生理盐水冲洗1遍。比较两组手术相关指标、并发症。结果:两组手术时间、手术部位、术中失血量、术中输血量、引流管放置时间、引流量及抗生素使用时间比较差异均无统计学意义(P>0.05)。碘伏组PJI发生率及总感染率均低于对照组,差异均有统计学意义(P<0.05);两组均未发生急性肾损伤及甲状腺功能损伤,两组切口延迟愈合或不愈合发生率比较差异无统计学意义(P>0.05)。结论:在初次关节置换手术安放假体前及关闭切口前使用碘伏溶液浸泡术野是一种能降低关节置换术后PJI风险的方法。

Objective:To investigate the clinical effect of iodopor immersion in the incision for prevention of periprosthetic infection(PJI)during primary total hip and knee replacement.Method:The clinical data of 293 patients who underwent primary total hip and knee replacement in our hospital from November 2014 to January 2018 were retrospectively analyzed.From February 2016,iodophor immersion and flushing were used in all joint replacement operations.In the control group(from November 2014 to January 2016,n=102),1 L normal saline was used to wash the operative field before and after placing the prosthesis and before closing the incision,in the iodopor group(from February 2016 to January 2018,n=191),0.5%iodopor solution was used to immerse the operative field for 2 min before and after placing the prosthesis and before closing the incision,and 1 L normal saline was used for washing once.The operation related indexes and complications were compared between the two groups.Result:There were no statistically significant differences between the two groups in operation time,operation site,intraoperative blood loss,intraoperative blood transfusion,drainage tube placement time,drainage volume and antibiotic use time(P>0.05).The incidence of PJI and total infection rate in the iodophor group were lower than those in the control group,the differences were statistically significant(P<0.05).No acute kidney injury or thyroid function injury occurred in the two groups,and there was no statistically significant difference in the incidence of delayed or nonunion between the two groups(P>0.05).Conclusion:Using iodophor solution to soak the surgical field before the prosthesis placement and before the incision closure is a method to reduce the risk of PJI after joint replacement.