Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9679, USA.
J Bone Joint Surg Am. 2013 Apr 17;95(8):e50. doi: 10.2106/JBJS.L.00596.
Total joint arthroplasty is one of the most common and most successful orthopaedic procedures. Infection after total joint arthroplasty is a devastating problem that expends patient, surgeon, and hospital resources, and it substantially decreases the chances of a successful patient outcome. Postoperative infection affects approximately 1% to 7% of all total joint arthroplasties, at a cost of approximately $50,000 per infection. Decreasing postoperative periprosthetic joint infection is of the utmost importance for the total joint arthroplasty surgeon. Preoperative, perioperative, intraoperative, and postoperative measures to minimize infection and optimize patient outcomes in total joint arthroplasty are discussed. Preoperative measures include management of patients colonized by Staphylococcus aureus, nutritional optimization, and management of medical comorbidities. Perioperative measures include skin preparation and prophylactic antibiotics. Intraoperative measures include body exhaust suits, laminar flow, ultraviolet light, operating-room traffic control, surgical suite enclosures, anesthesia-related considerations, and antibiotic-loaded bone cement. Postoperative measures include continued antibiotic prophylaxis, blood transfusions, hematoma formation and wound drainage, duration of hospital stay, and antibiotic prophylaxis for future invasive procedures.
全关节置换术是最常见和最成功的矫形手术之一。全关节置换术后感染是一个破坏性的问题，耗费了患者、外科医生和医院的资源，大大降低了患者成功的机会。术后感染影响了大约 1%到 7%的所有全关节置换术，每次感染的成本约为 5 万美元。减少全关节置换术后假体周围关节感染对全关节置换术外科医生来说至关重要。讨论了全关节置换术术前、围手术期、手术中和术后减少感染和优化患者结局的措施。术前措施包括金黄色葡萄球菌定植患者的管理、营养优化和合并症的管理。围手术期措施包括皮肤准备和预防性抗生素。术中措施包括身体排气服、层流、紫外线、手术室交通管制、手术套房围护结构、与麻醉相关的考虑因素以及载抗生素骨水泥。术后措施包括持续抗生素预防、输血、血肿形成和伤口引流、住院时间以及未来侵入性手术的抗生素预防。
