关节内万古霉素预防初次全膝关节置换术后早期假体周围关节感染的临床效果  

Clinical efficacy of intraarticular vancomycin in preventing early periprosthetic joint infection after primary knee arthroplasty

作　　者：张一帆 胡明玮 郭璀璀 杨雪[3] 王英振[1] 项帅 徐浩[1] Zhang Yifan;Hu Mingwei;Guo Cuicui;Yang Xue;Wang Yingzhen;Xiang Shuai;Xu Hao(Department of Joint Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Sports Medicine,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Operation Room,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学附属医院关节外科,青岛266000 [2]青岛大学附属医院运动医学科,青岛266000 [3]青岛大学附属医院手术室,青岛266000

出　　处：《中华外科杂志》2024年第6期591-597,共7页Chinese Journal of Surgery

摘　　要：目的探讨关节内注射万古霉素预防膝关节置换术早期假体周围关节感染(PJI)的临床效果及术后并发症情况。方法本研究为回顾性队列研究。回顾性分析2022年4月至2023年6月于青岛大学附属医院接受初次膝关节置换术的1867例患者的临床资料。男性687例,女性1180例,年龄(68.0±11.2)岁(范围:45~87岁)。根据术中关节囊闭合后是否于关节内注射万古霉素溶液(万古霉素粉1 g溶于30 ml 0.9%的氯化钠水溶液),将患者分为万古霉素组和对照组。万古霉素组925例,其中行全膝关节置换术(TKA)782例,机器人辅助全膝关节置换术(RA-TKA)27例,膝关节单髁表面置换术(UKA)116例。对照组942例,其中行TKA 767例,RA-TKA 99例,UKA 76例。评估患者术后3个月内早期PJI发生率、切口并发症情况,并观察万古霉素相关不良反应情况,包括急性肾功能衰竭、耳毒性和过敏反应等。采用独立样本t检验、χ^(2)检验或Fisher确切概率法对患者围手术期数据及随访资料进行比较。结果万古霉素组患者均未发生PJI;对照组TKA患者发生早期PJI 5例(0.7%,5/767),组间差异有统计学意义(P=0.030);对照组RA-TKA和UKA患者各发生早期PJI 1例,与万古霉素组的差异均无统计学意义(P值均>0.05)。万古霉素组TKA患者发生切口并发症2例(0.3%,2/782),对照组4例(0.5%,4/767),差异无统计学意义(P=0.449);万古霉素组RA-TKA患者未发生切口并发症,对照组发现1例(1.0%,1/99),差异无统计学意义(P>0.05);两组UKA患者均未发现切口并发症。所有患者未发生万古霉素相关的急性肾功能衰竭、耳毒性或过敏反应等。结论TKA术中关节囊关闭后关节内注射1 g万古霉素溶液对于降低术后早期PJI的发生率有一定价值,且不会增加切口并发症和万古霉素相关不良反应的发生率。Objective To investigate the clinical effect of intraarticular vancomycin on early periprosthetic joint infection(PJI)in knee arthroplasty and the incidence of postoperative complications.Methods This is a retrospective cohort study.The clinical data of 1867 patients who underwent primary knee arthroplasty at Department of Joint Surgery,the Affiliated Hospital of Qingdao University from April 2022 to June 2023 were retrospectively analysed,including total knee arthroplasty(TKA),robotic-assisted total knee arthroplasty(RA-TKA)and unicondylar knee arthroplasty(UKA).There were 687 males and 1180 females,aged(68.0±11.2)years(range:45 to 87 years).Patients were divided into the vancomycin group and the control group according to whether or not intra-articular injection of 1 g of vancomycin powder dissolved in 30 ml of saline was performed after intraoperative joint capsule closure.In the vancomycin group,925 patients were included,including 782 TKA,27 RA-TKA and 116 UKA.In the control group,942 patients were included,including 767 TKA,99 RA-TKA and 76 UKA.Early PJI,wound complications,and vancomycin-related toxicity including acute renal collapse,ototoxicity,and allergic reactions were assessed within 3 months postoperatively.The data were compared using the independent sample t test,χ^(2)test,and Fisher's exact probability method,as appropriate.Major Extremity Trauma Research Consortium(METRC).Results No PJI was found in all patients in the vancomycin group.Five cases(0.7%,5/767)of early PJI were found in TKA patients in the control group,with a statistically significant difference(P=0.030);1 case of early PJI was found in each RA-TKA and UKA patients,with non-significant difference compared with vancomycin group(all P>0.05).Two cases(0.3%,2/782)of incisional complications were found in TKA patients in the vancomycin group,and 4 cases(0.5%,4/767)of incisional complications were found in TKA patients in the control group,with non-significant difference(P=0.449);no incisional complication was found in RA-TKA patients

关 键 词：骨关节炎 膝 膝关节 人工 万古霉素 膝关节置换术 关节内 假体周围关节感染 术后并发症 

分 类 号：R687.4[医药卫生—骨科学]