Erken H Yener, Nusran Gurdal, Karagüven Doğaç, Yilmaz Onur, Kuru Tolgahan
Orthopaedics and Traumatology, Canakkale Onsekiz Mart University, Canakkale, TUR.
Orthopaedics and Traumatology, Ufuk University, Ankara, TUR.
Cureus. 2020 Sep 7;12(9):e10296. doi: 10.7759/cureus.10296.
Introduction The goal of this study was to evaluate the effects of local intra-wound vancomycin powder (VP) administration to decrease surgical site infections (SSIs), particularly in elderly patients with comorbidities, after having undergone partial hip replacement in the treatment of intertrochanteric (ITF) or femoral neck fractures (FNF). Methods We retrospectively reviewed patients who underwent partial hip replacement in the treatment of ITF or FNF in one year. We divided the patients into two groups. The non vancomycin-treated group received standard systemic prophylaxis only (1 gr cefazolin IV), while the vancomycin-treated group received 1 gr of VP in the surgical wound just before surgical closure in addition to the systemic prophylaxis. We included patients of 64 years or older who also had one or more comorbidities. We compared the post-operative SSI rates between the non vancomycin-treated group and the vancomycin-treated group. Results A total of 93 patients were included in the study. We detected post-operative wound infection in six patients (6.4%). The rate of SSI was found to be 5.7% in the vancomycin-treated group and 6.9% in the non vancomycin-treated group respectively, which showed no statistically significant difference (p:0.498). The incidence of SSI was statistically higher in the patients who had a follow-up in the post-operative intensive care unit than the patients who had not any follow-up in the intensive care unit. Conclusion Local application of VP in the surgical wound was found to be ineffective in reducing the incidence of SSI after partial hip replacement in elderly patients with comorbidities.
引言 本研究的目的是评估局部伤口内使用万古霉素粉末（VP）对降低手术部位感染（SSI）的效果，特别是在患有合并症的老年患者中，这些患者因转子间（ITF）或股骨颈骨折（FNF）接受了部分髋关节置换术。方法 我们回顾性分析了一年内因ITF或FNF接受部分髋关节置换术的患者。我们将患者分为两组。未使用万古霉素治疗的组仅接受标准的全身预防性用药（1克静脉注射头孢唑林），而使用万古霉素治疗的组除全身预防性用药外，在手术关闭前在手术伤口内使用1克VP。我们纳入了64岁及以上且患有一种或多种合并症的患者。我们比较了未使用万古霉素治疗的组和使用万古霉素治疗的组之间的术后SSI发生率。结果 本研究共纳入93例患者。我们在6例患者（6.4%）中检测到术后伤口感染。使用万古霉素治疗的组和未使用万古霉素治疗的组的SSI发生率分别为5.7%和6.9%，差异无统计学意义（p：0.498）。术后在重症监护病房接受随访的患者的SSI发生率在统计学上高于未在重症监护病房接受任何随访的患者。结论 发现在患有合并症的老年患者中，在手术伤口局部应用VP对降低部分髋关节置换术后SSI的发生率无效。
