Trauma & Orthopaedics, James Cook University Hospital, Middlesbrough, UK.
Limb Reconstruction Unit, Leeds General Infirmary, Leeds, UK.
Bone Joint J. 2021 Feb;103-B(2):279-285. doi: 10.1302/0301-620X.103B2.BJJ-2020-0680.R1.
Pin-site infection remains a significant problem for patients treated by external fixation. A randomized trial was undertaken to compare the weekly use of alcoholic chlorhexidine (CHX) for pin-site care with an emollient skin preparation in patients with a tibial fracture treated with a circular frame.
Patients were randomized to use either 0.5% CHX or Dermol (DML) 500 emollient pin-site care. A skin biopsy was taken from the tibia during surgery to measure the dermal and epidermal thickness and capillary, macrophage, and T-cell counts per high-powered field. The pH and hydration of the skin were measured preoperatively, at follow-up, and if pin-site infection occurred. Pin-site infection was defined using a validated clinical system.
Out of 116 patients who were enrolled in the study, 23 patients (40%) in the CHX group and 26 (44%) in the DML group had at least one bad or ugly pin-site infection. This difference was not statistically significant (p = 0.71). There was no significant relationship between pH or hydration of the skin and pin-site infection. The epidermal thickness was found to be significantly greater in patients who had a pin-site infection compared with those who did not (p = 0.01). Skin irritation requiring a change of treatment occurred in four patients (7%) using CHX, and none using DML.
We found no significant difference in the incidence of pin-site infection between the CHX and DML treatment groups. Dermol appeared to offer a small but significant advantage in terms of tolerability. We did not find a significant association between patient or treatment related factors and pin-site infection. It is therefore difficult to make specific recommendations based upon these results. The use of either cleaning agent appears to be appropriate. Cite this article: 2021;103-B(2):279-285.
经皮外固定治疗的患者，针道感染仍然是一个严重的问题。本研究采用随机对照试验，比较了每周使用酒精氯己定（CHX）和润肤剂 Dermol（DML）对环形外固定架固定胫骨骨折患者的针道护理效果。
患者被随机分为 CHX 组或 Dermol 组，分别使用 0.5% CHX 或 Dermol 500 进行针道护理。在手术时从胫骨上取皮肤活检，以测量真皮和表皮厚度以及每高倍视野的毛细血管、巨噬细胞和 T 细胞计数。在术前、随访时和出现针道感染时测量皮肤的 pH 值和水合作用。采用验证的临床系统定义针道感染。
在纳入研究的 116 例患者中，23 例（40%）CHX 组和 26 例（44%）DML 组至少有 1 例不良或难看的针道感染。差异无统计学意义（p = 0.71）。皮肤 pH 值或水合作用与针道感染无显著关系。与未发生针道感染的患者相比，发生针道感染的患者表皮厚度显著增加（p = 0.01）。使用 CHX 的患者中有 4 例（7%）出现皮肤刺激，需要改变治疗，而使用 DML 的患者中无一例出现。
我们发现 CHX 组和 DML 组之间针道感染的发生率无显著差异。Dermol 在耐受性方面有一定优势。我们没有发现患者或治疗相关因素与针道感染之间存在显著关联。因此，根据这些结果很难提出具体建议。使用这两种清洁剂似乎都是合适的。 引用本文：2021;103-B(2):279-285.
