庆大霉素处理自体肌腱对交叉韧带重建手术患者感染的控制  

Effect of treatment of autologous tendon with gentamicin on control of infections in patients undergoing cruciate ligament reconstruction surgery

作　　者：刘莉萍[1] 刘晓娜 侯春苗 史艳蕾[1] 王淑华[1] 

机构地区：[1]聊城市人民医院手术室,山东聊城252000 [2]东营市胜利油田中心医院呼吸内科,山东东营257000

出　　处：《中华医院感染学杂志》2016年第12期2800-2802,共3页Chinese Journal of Nosocomiology

基　　金：山东省自然基金资助项目(Y2006C80)

摘　　要：目的探讨庆大霉素处理自体肌腱对交叉韧带重建手术患者感染的影响,为控制交叉韧带重建手术患者的感染提供科学依据。方法将2011年1月-2015年6月实施交叉韧带重建手术的600例患者随机分为观察组与对照组,每组各300例,对照组在取自体肌腱之后采用无菌生理盐水浸泡洗涤肌腱,观察组采用加入庆大霉素的无菌生理盐水浸泡洗涤肌腱,对比两组患者的术后关节感染率,统计感染患者病原学分布,数据采用SPSS17.0软件进行统计分析。结果观察组患者交叉韧带重建手术后关节感染率为0.7%,显著低于对照组的6.4%,差异有统计学意义(P<0.01);关节感染患者红细胞沉降率、C-反应蛋白、纤维蛋白原水平显著上升,白细胞计数中度上升,关节腔穿刺液均为黄色浑浊液,以红白细胞为主;共分离出病原菌22株,主要为表皮葡萄球菌占54.4%、金黄色葡萄球菌占22.7%、溶血性葡萄球菌占13.6%;患者发现感染后即进行第2次关节镜下清创治疗,经治疗所有患者关节活动度均恢复正常,无并发症发生。结论在自体肌腱编织前后应用庆大霉素浸泡、洗涤与保湿自体肌腱,能够显著降低关节镜下交叉韧带重建手术患者的感染率。OBJECTIVE To explore the effect of treatment of autologous tendon with gentamicin on control of infections in patients undergoing cruciate ligament reconstruction surgery so as to provide scientific basis for control of the infections in the patients undergoing cruciate ligament reconstruction surgery.METHODS A total of 600 patients who underwent the cruciate ligament reconstruction surgery from Jan 2011 to Jun 2015 were enrolled in the study and randomly divided into the observation group and the control group.The control group was treated with sterile normal saline for soaking of the autologous tendon,while the observation group was treated with sterile normal saline containing gentamicin for soaking of the tendon.The incidence of postoperative joint infections was compared between the two groups of patients,the etiological distribution of the patients with infections was taken for statistics,and the statistical analysis of data was performed with the use of SPSS 17.0software.RESULTS The incidence of joint infections was 0.7%in the observation group after the cruciate ligament reconstruction surgery,significantly lower than 6.4%in the control group（P〈0.01）.The erythrocyte sedimentation rate and the levels of C-reactive protein and fibrinogen of the patients with joint infections were remarkably elevated,and the white blood cell counts were moderately increased;the puncture fluid of articular cavity was yellow turbid liquid,dominated by red and white cells.Totally 22 strains of pathogens were isolated,of which 54.4% were Staphylococcus epidermidis,22.7% were Staphylococcus aureus,and 13.6% were Staphylococcus haemolyticus.The patients with infections received the arthroscopic debridement for the second time,the joint range of motion of all the patients recovered after the treatment,and the complications did not occur.CONCLUSIONIt is an effective way to use gentamicin for soaking,cleaning,and moisturizing of the autologous tendon so as to reduce the infection rate of the patients undergoing arthroscopic cru

关 键 词：庆大霉素 自体肌腱 交叉韧带重建手术 感染 

分 类 号：R686[医药卫生—骨科学]