前言: 骨科术后内植物相关感染是灾难性的,虽然保持手术无菌操作及术前术后预防性应用抗生素已大大减少了此类事件的发生,但仍无法完全避免。内植物相关感染仍是悬在骨科医生头上的达摩克利斯之剑。
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参考文献:Qadir R, Costales
T, Coale M, Mulliken A, Zerhusen T Jr, Joshi M, Castillo RC, Carlini AR,
O'Toole RV. Vancomycin Powder Use in Fractures at High Risk of Surgical
Site Infection. J Orthop Trauma. 2021 Jan 1;35(1):23-28. 骨科术后一旦感染,菌群定植于内植物将难以清除,成为潜伏在体内的“定时炸弹”,急性感染未控制,甚至需取除内植物,意味着手术的失败。在脊柱手术中,万古霉素粉剂直接应用于伤口预防感染已经较广泛的应用,无论中外均有较多报道,而对创伤骨科手术相关的报道较少。
为解决上述疑问,约翰.霍普金斯的学者对易发生感染的胫骨双平台骨折、Pilon骨折及跟骨骨折术中使用万古霉素粉剂直接作用于伤口,取得较好效果。相关研究发表在2021.01最新JOT杂志上。
为了明确在伤口内使用万古霉素粉剂是否可减少胫骨双平台、Pilon骨折和跟骨骨折切开复位内固定术后的手术部位感染。 (To determine if the use of intrawound vancomycin powder reduces surgical-site infection after open reduction and internal fixation of bicondylar tibial plateau, tibial pilon, and calcaneus fractures.)
(Retrospective analysis.)回顾性分析了2011年1月至2015年2月所有手术治疗的骨折患者。纳入583例高风险骨折,其中35例接受了局部应用万古霉素粉剂治疗。 从2007年至2010年在我们中心治疗的235例类似的高风险骨折的前瞻性队列作为第二个对照组。(All fractures operatively treated from January 2011 to February 2015 were reviewed; 583 high-risk fractures were included, of which 35 received topical vancomycin powder. A previously published prospectively collected cohort of 235 similar high-risk fractures treated at our center from 2007 through 2010 served as a second comparison group.)
与同时间段手术治疗但未使用万古霉素粉剂的骨折对照组相比,万古霉素显著降低了感染率[0% (0/35) vs.10.6% (58/548), P = 0.04]。与前期发表的类似骨折13%的感染率相比,万古霉素也显著降低了深部手术部位感染率 (0% vs. 13%, P = 0.02)。这些结果与匹配的分析一致,这也表明万古霉素粉剂组的感染率较低 (0% vs. 11%–16%, P<0.05)。 (注:万古霉素使用方法,1g万古霉素直接应用于内植物表面,不与生理盐水或其他材料混合)
(Compared with a control group of fractures treated during the same time period without vancomycin powder, the infection rate with vancomycin powder was significantly lower [0% (0/35) vs.10.6% (58/548), P = 0.04]. Compared with our previously published historical infection rate of 13% for these injuries, vancomycin powder was also associated with significantly decreased deep surgicalsite infection (0% vs. 13%, P = 0.02). These results agreed with the matched analyses, which also showed lower infection in the vancomycin powder group (0% vs. 11%–16%, P<0.05). )
万古霉素粉剂可能在降低骨折内固定术后手术部位感染率中起重要作用。但还需要更大样本的随机对照研究来验证我们的发现。
(Vancomycin powder may play a role in lowering surgical-site infection rates after fracture fixation. A larger randomized controlled trial is needed to validate our findings.)
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------------------------------总结|钢板的6大功能
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资源|骨科书籍+视频分享第三弹!(附全部下载方式)