Marecek Geoffrey S, Weatherford Brian M, Fuller Eric B, Saltzman Matthew D
Department of Orthopaedic Surgery, University of Southern California Keck School of Medicine, Los Angeles, CA, USA.
Department of Orthopaedic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2015 May;24(5):804-8. doi: 10.1016/j.jse.2014.10.007. Epub 2014 Dec 3.
Infection after shoulder surgery can have devastating consequences. Recent literature has implicated Propionibacterium acnes as a causative agent for postoperative shoulder infections. Axillary hair removal has been suggested as a method for infection prevention, although data quantifying its effect on the bacterial load around the shoulder are lacking.
We clipped one randomly selected axilla in 85 healthy male volunteers with commercially available surgical clippers. Aerobic and anaerobic culture specimens were taken from the clipped and unclipped axillae. Each shoulder was then prepared with 2% chlorhexidine gluconate and 70% isopropyl alcohol. Repeated culture specimens were then taken from both axillae. Cultures were held for 14 days and recorded with a semiquantitative system (0-4 points). Results were compared by the Wilcoxon signed rank test.
There was no difference in the burden of P. acnes between the clipped and unclipped axillae before or after surgical preparation (P = .109, P = .344, respectively). There was a significantly greater bacterial burden in the clipped shoulder compared with the unclipped shoulder before preparation (P < .001) but not after preparation (P = .285). There was a significant reduction in total bacterial load and P. acnes load for both axillae after surgical preparation (P < .001 for all).
Removal of axillary hair has no effect on the burden of P. acnes in the axilla. Clipped axillae had a higher total bacterial burden. A 2% chlorhexidine gluconate surgical preparation is effective at removal of all bacteria and specifically P. acnes from the axilla.
肩部手术后感染可能会产生严重后果。近期文献表明痤疮丙酸杆菌是术后肩部感染的病原体。虽然缺乏量化其对肩部周围细菌载量影响的数据，但已有人提出去除腋毛是一种预防感染的方法。
我们用市售手术剪随机修剪了85名健康男性志愿者一侧的腋毛。从修剪和未修剪的腋窝采集需氧和厌氧培养标本。然后用2%葡萄糖酸氯己定和70%异丙醇对每个肩部进行准备。之后再次从两侧腋窝采集培养标本。培养14天，并用半定量系统（0 - 4分）记录结果。结果采用Wilcoxon符号秩检验进行比较。
手术准备前后，修剪和未修剪腋窝的痤疮丙酸杆菌载量无差异（分别为P = 0.109，P = 0.344）。准备前，修剪侧肩部的细菌载量明显高于未修剪侧肩部（P < 0.001），但准备后无差异（P = 0.285）。手术准备后，两侧腋窝的总细菌载量和痤疮丙酸杆菌载量均显著降低（所有P < 0.001）。
去除腋毛对腋窝痤疮丙酸杆菌载量无影响。修剪过腋毛的腋窝总细菌载量更高。2%葡萄糖酸氯己定手术准备可有效去除腋窝所有细菌，尤其是痤疮丙酸杆菌。
