初次全关节置换术中伤口内注射后血清及伤口万古霉素水平
Serum and Wound Vancomycin Levels After Intrawound Administration in Primary Total Joint Arthroplasty.
作者信息
Johnson Jeremiah D, Nessler Joseph M, Horazdovsky Ryan D, Vang Sandy, Thomas Avis J, Marston Scott B
机构信息
Department of Orthopaedic Surgery, Regions Hospital, St. Paul, Minnesota; Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
Creighton University School of Medicine, Omaha, Nebraska.
出版信息
J Arthroplasty. 2017 Mar;32(3):924-928. doi: 10.1016/j.arth.2015.10.015. Epub 2015 Oct 26.
BACKGROUND
Periprosthetic joint infection is the most common cause of readmissions after total joint arthroplasty (TJA). Intrawound vancomycin powder (VP) has reduced infection rates in spine surgery; however, there are no data regarding VP in primary TJA.
METHODS
Thirty-four TJA patients received 2 g of VP intraoperatively to investigate VP's pharmacokinetics. Serum and wound concentrations were measured at multiple intervals over 24 hours after closure.
RESULTS
All serum concentrations were subtherapeutic (<15μg/mL) and peaked 12 hours after closure (4.7μg/mL; standard deviation [SD], 3.2). Wound concentrations were 922 μg/mL (SD, 523) 3 hours after closure and 207 μg/mL (SD, 317) at 24 hours. VP had a half-life of 7.2 hours (95% confidence interval, 7.0-9.3) in TJA wounds.
CONCLUSIONS
VP produced highly therapeutic intrawound concentrations while yielding low systemic levels in TJA. VP may serve as a safe adjunct in the prevention of periprosthetic joint infection.
背景
人工关节周围感染是全关节置换术（TJA）后再次入院的最常见原因。伤口内注射万古霉素粉末（VP）可降低脊柱手术的感染率；然而，关于原发性TJA中VP的数据尚无报道。
方法
34例TJA患者术中接受2g VP以研究VP的药代动力学。在伤口闭合后24小时内的多个时间点测量血清和伤口浓度。
结果
所有血清浓度均低于治疗水平（<15μg/mL），并在伤口闭合后12小时达到峰值（4.7μg/mL；标准差[SD]，3.2）。伤口闭合后3小时的伤口浓度为922μg/mL（SD，523），24小时时为207μg/mL（SD，317）。VP在TJA伤口中的半衰期为7.2小时（95%置信区间，7.0-9.3）。
结论
VP在TJA中产生了高治疗性的伤口内浓度，同时全身水平较低。VP可作为预防人工关节周围感染的安全辅助手段。
Zotero 插件