Wang Hanzhou, Liu Yang, Shi Zongxin, Wang Dong, Zhang Hui, Diao Shuo, Xu Xiaopei, Waheed Muhammad Zeeshan, Lu Tianchao, Zhou Junlin
Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing 100020, PR China.
Department of Orthopedic Surgery, Beijing Liangxiang Hospital, Beijing 102446, PR China.
Injury. 2023 Apr;54(4):1088-1094. doi: 10.1016/j.injury.2023.01.055. Epub 2023 Feb 3.
Despite the improvements in surgical techniques and the use of prophylactic intravenous antibiotics, the fracture-related infection (FRI) incidence after high-risk tibial plateau fractures remains high. This study aimed to evaluate the clinical effect of the intrawound application of vancomycin on the FRI after high-risk tibial plateau fracture surgery.
A total of 243 patients who underwent high-risk tibial plateau fracture surgery from May 2013 to June 2021 were retrospectively reviewed. Of these, 233 cases were enrolled. Considering the preoperative patient condition, surgeons applied vancomycin powder directly into the surgical site before wound closure in 105 cases (intrawound application of vancomycin powder with preoperative intravenous cephalosporin). The remaining 128 cases served as the control group (preoperative intravenous cephalosporin alone). Clinical data and surgical details were recorded. The Cox proportional hazards regression analysis was used to assess risk factors for FRI. The Kaplan-Meier method and the log rank test illustrated the infection status of patients based on the application of intrawound vancomycin. The primary outcome was an FRI within one year. Secondary outcomes included bacterial culture and vancomycin-related complications.
Our study demonstrated a significant difference in the incidence of FRI between the vancomycin group and the control group (3.8% versus 10.9%; p=0.041). Multivariable Cox regression showed the intrawound application of vancomycin powder decreased the rate of FRI. There were no complications related to intrawound vancomycin observed during follow-up. The presence of Gram-positive FRI was higher in the control group compared with the vancomycin group.
Intrawound application of vancomycin was associated with a significant lower rate of FRI after high-risk tibial plateau fracture surgery compared to the control group.
尽管手术技术有所改进且使用了预防性静脉抗生素，但高危胫骨平台骨折后骨折相关感染（FRI）的发生率仍然很高。本研究旨在评估伤口内应用万古霉素对高危胫骨平台骨折手术后FRI的临床效果。
回顾性分析2013年5月至2021年6月期间接受高危胫骨平台骨折手术的243例患者。其中，233例被纳入研究。考虑到术前患者情况，105例患者（伤口内应用万古霉素粉末并术前静脉使用头孢菌素）在伤口闭合前由外科医生直接将万古霉素粉末应用于手术部位。其余128例作为对照组（仅术前静脉使用头孢菌素）。记录临床数据和手术细节。采用Cox比例风险回归分析评估FRI的危险因素。Kaplan-Meier法和对数秩检验根据伤口内万古霉素的应用情况阐述患者的感染状况。主要结局是一年内发生FRI。次要结局包括细菌培养和万古霉素相关并发症。
我们的研究表明万古霉素组和对照组之间FRI发生率存在显著差异（3.8%对10.9%；p = 0.041）。多变量Cox回归显示伤口内应用万古霉素粉末降低了FRI发生率。随访期间未观察到与伤口内万古霉素相关的并发症。与万古霉素组相比，对照组革兰氏阳性FRI的发生率更高。
与对照组相比，高危胫骨平台骨折手术后伤口内应用万古霉素与显著更低的FRI发生率相关。
