Shadid Marwan B, Speth Mario J G M, Voorn G Paul, Wolterbeek Nienke
Orthopedic Surgeon, Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands.
Medical Doctor and Microbiologist, Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands.
J Foot Ankle Surg. 2019 Mar;58(2):278-281. doi: 10.1053/j.jfas.2018.08.042. Epub 2019 Jan 3.
No consensus exists regarding which cleansing technique, solution, and concentration should be used in orthopedic surgery. The aim of this randomized, controlled trial was to compare the effect of chlorhexidine 0.5%/70% alcohol with iodine 1%/70% alcohol on lowering positive cultures before elective foot surgery and to study any wound complications, infections and allergic reactions. Consecutive patients ≥18 years of age scheduled for a hallux valgus correction or arthrodesis of the first metatarsophalangeal joint were included. Swabs were taken from 2 sites before and twice after preparing the skin and were quantitatively and qualitatively analyzed. The study group consisted of 49 patients with a mean age of 52.3 ± 14.4 (range 22 to 75) years of whom 42 (86%) were female. No significant differences were observed for positive cultures between the chlorhexidine (73%, 2%, and 12%) and iodine (68%, 7%, and 9%) group at any time point. Coagulase-negative staphylococci were the most commonly isolated micro-organisms found after skin preparation. Occasionally, Bacillus spp and Corynebacterium spp were cultured. The complication rate 2 weeks postoperatively was 0% in the chlorhexidine group versus 8.7% (n = 2) in the iodine group (delayed wound healing; p = .215). The complication rate at 6 weeks postoperatively was, respectively, 3.8% (n = 1) versus 4.3% (n = 1; both showed swelling and redness; p > .999). There was no significant difference in postoperative wound problems or infection rates between the 2 skin preparation solutions. Chlorhexidine 0.5%/70% alcohol and iodine 1%/70% alcohol both decreased the amount of positive cultures in elective foot surgery.
关于在骨科手术中应使用哪种清洁技术、溶液和浓度，目前尚无共识。这项随机对照试验的目的是比较0.5%洗必泰/70%酒精与1%碘/70%酒精在择期足部手术前降低阳性培养物的效果，并研究任何伤口并发症、感染和过敏反应。纳入了计划进行拇外翻矫正或第一跖趾关节融合术的18岁及以上连续患者。在皮肤准备前和准备后两次从2个部位采集拭子，并进行定量和定性分析。研究组由49例患者组成，平均年龄为52.3±14.4岁（范围22至75岁），其中42例（86%）为女性。在任何时间点，洗必泰组（73%、2%和12%）和碘组（68%、7%和9%）之间的阳性培养物均未观察到显著差异。凝固酶阴性葡萄球菌是皮肤准备后最常分离出的微生物。偶尔会培养出芽孢杆菌属和棒状杆菌属。洗必泰组术后2周的并发症发生率为0%，而碘组为8.7%（n = 2；伤口愈合延迟；p = 0.215）。术后6周的并发症发生率分别为3.8%（n = 1）和4.3%（n = 1；均表现为肿胀和发红；p > 0.999）。两种皮肤准备溶液在术后伤口问题或感染率方面没有显著差异。0.5%洗必泰/70%酒精和1%碘/70%酒精在择期足部手术中均降低了阳性培养物的数量。
