Knobben Bas A S, Engelsma Yde, Neut Daniëlle, van der Mei Henny C, Busscher Henk J, van Horn James R
Department of Orthopaedic Surgery, University of Groningen Medical Center, Groningen, The Netherlands.
Clin Orthop Relat Res. 2006 Nov;452:236-41. doi: 10.1097/01.blo.0000229339.11351.ea.
Intraoperative bacterial contamination increases risk for postoperative wound-healing problems and periprosthetic infection, but to what extent remains unclear. We asked whether bacterial contamination of the instruments and bone during primary prosthesis insertion was associated with prolonged wound discharge and subsequent periprosthetic infection. During 100 total hip arthroplasties, four intraoperative cultures were taken from the instruments and two portions of removed bone. Postoperatively, the duration of wound discharge was monitored, with Day 5 as the cut-off point. All patients were followed for 2 years to determine whether periprosthetic infection occurred. Bacterial contamination occurred in 36 operative procedures (36%). We found an association between intraoperative contamination and prolonged wound discharge, with a relative risk of 2.5. The culturing of removed bone had a positive predictive value of 81% to 90%. Other factors associated with prolonged wound discharge were rheumatoid arthritis (relative risk, 6.4), use of cement (relative risk, 1.6), and increased blood loss (relative risk, 1.5).
术中细菌污染会增加术后伤口愈合问题和假体周围感染的风险，但具体程度尚不清楚。我们探讨了初次植入假体过程中器械和骨的细菌污染是否与伤口引流时间延长及随后的假体周围感染有关。在100例全髋关节置换术中，从器械和两段取出的骨组织中进行了4次术中培养。术后，以第5天为截止点监测伤口引流时间。对所有患者随访2年以确定是否发生假体周围感染。36例手术操作（36%）出现细菌污染。我们发现术中污染与伤口引流时间延长之间存在关联，相对风险为2.5。取出骨组织的培养阳性预测值为81%至90%。与伤口引流时间延长相关的其他因素包括类风湿性关节炎（相对风险为6.4）、使用骨水泥（相对风险为1.6）和失血增加（相对风险为1.5）。
