Department of Orthopaedics, Middlemore Hospital, Private Bag 93311, Otahuhu, Auckland 1640, New Zealand.
Clin Orthop Relat Res. 2013 Jan;471(1):244-9. doi: 10.1007/s11999-012-2469-2.
Prophylactic antibiotics reduce the risk of deep infection after primary TKA. However, conventional systemic dosing may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Regional intravenous administration of antibiotics after tourniquet inflation achieves far higher tissue concentrations but requires foot vein cannulation. The intraosseous route may offer a rapid and reliable method of regional administration.
QUESTIONS/PURPOSES: We compared tissue concentrations of cefazolin achieved with systemic versus regional intraosseous administration.
Twenty-two patients undergoing primary TKA were randomized into two groups. Group 1 received 1 g cefazolin systemically 10 minutes before tourniquet inflation. Group 2 received 1 g cefazolin intraosseously in 200 mL of normal saline through a tibial cannula after tourniquet inflation and before skin incision. Subcutaneous fat and femoral bone samples were taken at set intervals during the procedure and antibiotic concentrations measured using a validated technique involving high-performance liquid chromatography.
The overall mean tissue concentration of cefazolin in subcutaneous fat was 186 ug/g in the intraosseous group and 11 ug/g in the systemic group. The mean tissue concentration in bone was 130 ug/g in the intraosseous group and 11 ug/g in the systemic group. These differences were consistent across all sample time points throughout the procedure.
Intraosseous regional administration can achieve concentrations of antibiotic in tissue an order of magnitude higher than systemic administration. Further work is required to determine if this translates into increased efficacy in preventing infection, particularly against coagulase-negative staphylococci.
预防性抗生素可降低初次全膝关节置换术后深部感染的风险。然而，常规全身给药可能无法提供针对凝固酶阴性葡萄球菌等更耐药的生物的足够组织浓度。在止血带充气后，局部静脉内给予抗生素可实现更高的组织浓度，但需要进行足部静脉置管。骨内途径可能提供一种快速可靠的局部给药方法。
问题/目的：我们比较了全身和局部骨内给药时头孢唑林的组织浓度。
22 例行初次全膝关节置换术的患者被随机分为两组。第 1 组在止血带充气前 10 分钟接受 1 g 头孢唑林全身给药。第 2 组在止血带充气后和皮肤切开前，通过胫骨套管向 200 mL 生理盐水内给予 1 g 头孢唑林进行局部骨内给药。在手术过程中设定的时间间隔采集皮下脂肪和股骨样本，并使用涉及高效液相色谱的验证技术测量抗生素浓度。
骨内组的皮下脂肪中头孢唑林的总体平均组织浓度为 186 μg/g，全身组为 11 μg/g。骨内组的骨组织浓度为 130 μg/g，全身组为 11 μg/g。这些差异在整个手术过程中的所有样本时间点都是一致的。
骨内局部给药可以实现比全身给药高一个数量级的抗生素组织浓度。需要进一步的工作来确定这是否转化为预防感染的效果增加，特别是针对凝固酶阴性葡萄球菌。
