Best A J, Nixon M F, Taylor G J S
Department of Orthopaedic Surgery, Glenfield Hospital, Leicester, UK.
J Hosp Infect. 2007 Sep;67(1):67-71. doi: 10.1016/j.jhin.2007.05.014. Epub 2007 Jul 30.
Jet lavage with chlorhexidine 0.05% is an effective means of wound decontamination with 99% of bacteria removed or killed after 1min. Reports of chondrolysis following exposure to concentrations of >0.05% or prolonged exposure to chlorhexidine have curtailed its use in orthopaedic practice. Using radiolabelled sulphur uptake to measure cartilage metabolism, we quantitatively assessed the in-vitro effect of osteoarthritic and non-osteoarthritic human cartilage exposure to chlorhexidine 0.05% for 1min and 1h. The metabolism of non-osteoarthritic cartilage was not significantly affected by a 1min exposure to chlorhexidine 0.05% whereas that of osteoarthritic cartilage was markedly impaired. Prolonged exposure for 1h markedly affected both types of cartilage. These results are encouraging in that 0.05% chlorhexidine may have a role in the decontamination of contaminated open joint injuries in patients with no signs of osteoarthritis. Until there is further understanding of the mechanism underlying reported incidents of chondrolysis following its use, however, it cannot be recommended for the irrigation of 'clean' articular cartilage.
用0.05%的氯己定进行喷射冲洗是一种有效的伤口去污方法，1分钟后99%的细菌会被清除或杀死。有报告称，接触浓度>0.05%的氯己定或长期接触氯己定后会发生软骨溶解，这限制了其在骨科实践中的应用。我们使用放射性标记的硫摄取来测量软骨代谢，定量评估了骨关节炎和非骨关节炎的人体软骨在体外暴露于0.05%氯己定1分钟和1小时后的影响。非骨关节炎软骨暴露于0.05%氯己定1分钟后，其代谢没有受到显著影响，而骨关节炎软骨的代谢则明显受损。延长暴露1小时对两种类型的软骨都有明显影响。这些结果令人鼓舞，因为0.05%的氯己定可能在没有骨关节炎迹象的患者的开放性关节损伤污染去污中发挥作用。然而，在对其使用后报告的软骨溶解事件的潜在机制有进一步了解之前，不建议用于冲洗“清洁”的关节软骨。
