Schindler O S, Spencer R F, Smith M D
Droitwich Knee Clinic, St Andrews Road, Droitwich Spa, Worcestershire WR9 8YX, UK.
J Bone Joint Surg Br. 2006 Mar;88(3):382-5. doi: 10.1302/0301-620X.88B3.17155.
The aim of this study was to re-assess whether the use of a 'one-knife technique' can be considered as safe as the alternative practice of using separate skin and inside knives for elective orthopaedic surgery. A total of 609 knife blades from 203 elective orthopaedic operations, with equal numbers of skin, inside and control blades, were cultured using direct and enrichment media. We found 31 skin blades (15.3%), 22 inside blades (10.8%), and 13 control blades (6.4%) gave bacterial growth. Of the 31 contaminated skin blades only three (9.7%) had growth of the same organism as found on the corresponding inside blade. It is not known whether contamination of deeper layers in the remaining 90% was prevented by changing the knife after the skin incision. The organisms cultured were predominantly coagulase-negative staphylococci and proprionibacterium species; both are known to be the major culprits in peri-prosthetic infection. Our study suggests that the use of separate skin and inside knives should be maintained as good medical practice, since the cost of a single deep infection in human and financial terms can be considerable.
本研究的目的是重新评估在择期骨科手术中，使用“一刀技术”是否能被认为与使用单独的皮肤刀和深部组织刀的传统做法一样安全。对203例择期骨科手术中总共609把刀片（皮肤刀、深部组织刀和对照刀数量相等），使用直接培养法和增菌培养基进行培养。我们发现31把皮肤刀（15.3%）、22把深部组织刀（10.8%）和13把对照刀（6.4%）有细菌生长。在31把受污染的皮肤刀中，只有3把（9.7%）与相应深部组织刀上发现的是同一种微生物生长。尚不清楚在其余90%的病例中，皮肤切开后更换刀具是否能防止深层组织污染。培养出的微生物主要是凝固酶阴性葡萄球菌和丙酸杆菌属；这两种都是已知的假体周围感染的主要致病菌。我们的研究表明，使用单独的皮肤刀和深部组织刀应作为良好的医疗实践予以维持，因为一次深部感染在人力和财力方面的代价可能相当大。
