Yu Anthony L, Alfieri David C, Bartucci Kristen N, Holzmeister Adam M, Rees Harold W
Department of Orthopaedic Surgery and Rehabilitation, Loyola University Chicago, Maywood, IL.
J Arthroplasty. 2016 Oct;31(10):2256-9. doi: 10.1016/j.arth.2016.03.040. Epub 2016 Mar 30.
Current literature is limited with regard to standardized postoperative surgical site hygiene after total knee arthroplasty (TKA). With little guidance from the literature, the timing of permissible postoperative cleaning is a decision made by the individual surgeon using anecdotal evidence. A standardized wound care regimen is of particular interest to minimize the risk of infection.
To examine what species of bacteria recolonize the surgical site postoperatively, a randomized controlled trial was performed of 16 TKA patients who were allowed to shower at 2 days postoperatively and of 16 patients who were asked to wait until 2 weeks postoperatively before showering after TKA. Culture swabs of skin adjacent to the incision were performed preoperatively, just after incision closure, at dressing removal, and at 2 weeks postoperatively. Bacteria were speciated and compared between groups. A swab of the contralateral knee was performed at 2 weeks as a control. A survey of patient's preference regarding early and late showering was also carried out.
No difference was found between the groups in rate of colonization or bacterial type, and no patients developed infection. Patients overwhelmingly preferred early showering rather than late (P = .28-.99).
There is no difference in surgical site bacterial recolonization between early and delayed showering after primary TKA.
目前关于全膝关节置换术（TKA）术后手术部位标准化卫生处理的文献有限。由于文献指导较少，术后允许清洁的时间是由外科医生根据经验证据做出的决定。标准化的伤口护理方案对于将感染风险降至最低尤为重要。
为了研究术后手术部位重新定植的是何种细菌，对16例TKA患者进行了一项随机对照试验，这些患者在术后2天被允许淋浴，另外16例患者在TKA术后被要求等到2周后再淋浴。在术前、切口闭合后、拆除敷料时以及术后2周对切口附近皮肤进行培养拭子采样。对细菌进行分类并在组间进行比较。在2周时对侧膝关节进行拭子采样作为对照。还对患者关于早期和晚期淋浴的偏好进行了调查。
两组在定植率或细菌类型方面没有差异，且没有患者发生感染。绝大多数患者更喜欢早期淋浴而非晚期淋浴（P = 0.28 - 0.99）。
初次TKA术后早期和延迟淋浴在手术部位细菌重新定植方面没有差异。
