不同剂量万古霉素骨水泥在全膝关节置换术中的应用研究  

Application of different doses of vancomycin bone cement in total knee arthroplasty

作　　者：温振涛 赵志光 赵莹 温存宁 方庆山[1] 葛满意[5] WEN Zhen-tao;ZHAO Zhi-guang;ZHAO Ying;WEN Cun-ning;FANG Qing-shan;GE Man-yi(Second Department of Osteoarthritis,Handan First Hospital,Handan Hebei 056000,China;Third Department of Orthopedics,Handan Hospital,Fengfeng General Hospital of North China Medical and Health Group,Handan Hebei 056001,China;Department of Orthopedics,the Second Affiliated Hospital of Xingtai Medical College,Xingtai Hebei 054000,China;Department of Emergency,Handan First Hospital,Handan Hebei 056000,China;Forth Department of Osteoarthritis,Handan First Hospital,Handan Hebei 056000,China)

机构地区：[1]邯郸市第一医院骨关节二科,河北邯郸056000 [2]华北医疗健康集团峰峰总医院邯郸院区骨三科,河北邯郸056001 [3]邢台医学高等专科学校第二附属医院骨科,河北邢台054000 [4]邯郸市第一医院急诊科,河北邯郸056000 [5]邯郸市第一医院骨关节四科,河北邯郸056000

出　　处：《局解手术学杂志》2024年第6期501-504,共4页Journal of Regional Anatomy and Operative Surgery

基　　金：河北省2023年度医学科学研究课题计划(20231916)。

摘　　要：目的研究不同剂量万古霉素骨水泥对全膝关节置换术患者血清炎症因子及关节功能的影响。方法选择邯郸市第一医院2021年8月至2023年1月收治的接受全膝关节置换术的128例患者为研究对象,根据随机数字表法分为A组(未添加万古霉素的丙烯酸树脂骨水泥)、B组(每40 g丙烯酸树脂骨水泥添加0.5 g万古霉素)、C组(每40 g丙烯酸树脂骨水泥添加1.0 g万古霉素)、D组(每40 g丙烯酸树脂骨水泥添加2.0 g万古霉素),每组32例。采用高效液相色谱法检测B组、C组、D组患者术后不同时点引流液中的万古霉素药物浓度;于术前、术后7 d、术后6个月采用免疫散射比浊法、魏氏法检测4组患者血清C反应蛋白(CRP)、红细胞沉降率(ESR)水平;采用特种外科医院膝关节评分(HSS)评估4组患者术前、术后6个月的膝关节功能。结果B组、C组、D组患者引流液中万古霉素药物浓度随剂量的增加而增加(P<0.05),随时间的延长而降低(P<0.05)。4组患者术后血清CRP、ESR水平随时间的延长先升高,后降低(P<0.05)。B组、C组、D组患者术后7 d、术后6个月血清中CRP、ESR水平均明显低于A组(P<0.05),C组、D组患者术后7 d、术后6个月血清中CRP、ESR水平均明显低于B组(P<0.05),而C组与D组患者的血清CRP、ESR水平无明显差异(P>0.05)。4组患者术后6个月的HSS评分均显著提高(P<0.05);B组、C组、D组患者术后6个月的HSS评分高于A组(P<0.05),C组、D组患者术后6个月的HSS评分明显高于B组(P<0.05),C组、D组患者术后6个月的HSS评分无显著性差异(P>0.05)。结论使用经万古霉素浸渍的骨水泥能够显著降低全膝关节置换术患者的血清炎症因子CRP、ESR水平,可防治术后感染,改善患者的关节功能,不同剂量万古霉素的作用程度也不同,推荐以1.0 g万古霉素应用于临床实践。Objective To study the effects of different doses of vancomycin bone cement on serum inflammatory factors and joint function in patients undergoing total knee arthroplasty.Methods A total of 128 patients who underwent total knee arthroplasty admitted to Handan First Hospital from August 2021 to January 2023 were selected as the study subjects.They were divided into group A(acrylic bone cement without vancomycin),group B(0.5 g vancomycin per 40 g acrylic bone cement),group C(1.0 g vancomycin per 40 g acrylic bone cement)and group D(2.0 g vancomycin per 40 g acrylic bone cement)by random number table method,with 32 patients in each group.High performance liquid chromatography was used to detect the concentration of vancomycin in drainage fluid at different time points after operation of patients in group B,group C,and group D.Immune scattering turbidimetry and Westergren method were used to detect the levels of serum C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)of patients in the four groups before operation,7 days and 6 months after operation.Hospital for special surgery knee score(HSS)was used to evaluate the knee joint function of patients in the four groups before operation and 6 months after operation.Results The concentration of vancomycin in drainage fluid of patients in group B,group C,and group D increased with the increase of dose(P<0.05),and decreased with the extension of time(P<0.05).The postoperative serum CRP and ESR levels in the four groups increasing first and then decreased with time(P<0.05).The levels of serum CRP and ESR 7 days and 6 months after operation of patients in group B,group C,and group D were significantly lower than those in group A(P<0.05).The levels of serum CRP and ESR 7 days and 6 months after operation of patients in group C and group D were significantly lower than those in group B(P<0.05),while there was no significant difference in serum CRP and ESR levels between group C and group D(P>0.05).The HSS scores 6 months after operation of patients in the four gro

关 键 词：全膝关节置换术 万古霉素 骨水泥 剂量 炎症 膝关节功能 

分 类 号：R684.3[医药卫生—骨科学]