Department of Orthopaedics, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No 26, Daoqian Street, Suzhou, 215000, Jiangsu, People's Republic of China.
Department of Laboratory, Suzhou Municipal Hospital, The Affiliated Hospital of Nanjing Medical University, No 26, Daoqian Street, Suzhou, 215000, Jiangsu, People's Republic of China.
Arch Orthop Trauma Surg. 2024 Sep;144(9):4069-4075. doi: 10.1007/s00402-023-05108-1. Epub 2023 Oct 30.
Prophylactic antibiotics reduce the risk of periprosthetic joint infection. However, conventional systemic administration may not provide adequate tissue concentrations against more resistant organisms such as coagulase-negative staphylococci. Intraosseous regional administration is known to achieve significantly higher antibiotic tissue concentrations than systemic administration, but it is unclear how synovial fluid concentrations are affected. We aimed to compare synovial fluid cefazolin concentrations achieved by regional intraosseous versus systemic intravenous administration, and also to compare synovial fluid cefazolin concentrations with those in subcutaneous fat.
A total of 60 patients undergoing primary knee arthroplasty were randomized into 2 groups: group IO received 2 g interosseous cefazolin in 100 mL saline through a tibial cannula after tourniquet inflation and before skin incision; group IV received 2 g cefazolin in 100 mL saline via the median basilic or median cephalic vein 30 min before tourniquet inflation. Subcutaneous fat and synovial fluid samples were collected immediately after skin incision, and cefazolin concentrations were measured by high-performance liquid chromatography.
The cefazolin concentration in synovial fluid was 391.3 ± 70.1 μg/ml in group IO and 17.6 ± 3.5 μg/ml in group IV. The cefazolin concentration in subcutaneous fat was 247.9 ± 64.9 μg/g in group IO and 11.4 ± 1.9 μg/g in group IV.
Intraosseous regional administration results in several times higher tissue concentrations than systemic administration, especially in the synovial fluid.
预防性使用抗生素可以降低假体周围关节感染的风险。然而，传统的全身给药方式可能无法为凝固酶阴性葡萄球菌等更具耐药性的病原体提供足够的组织浓度。已知骨内区域性给药可实现比全身给药更高的抗生素组织浓度，但关节滑液浓度的影响尚不清楚。我们旨在比较骨内区域性给药和全身静脉内给药时关节滑液头孢唑林的浓度，并比较关节滑液头孢唑林浓度与皮下脂肪中的浓度。
共有 60 例接受初次膝关节置换术的患者随机分为 2 组：IO 组在止血带充气前和皮肤切开前，通过胫骨套管向 100ml 生理盐水内注射 2g 头孢唑林；IV 组在止血带充气前 30 分钟，通过正中尺或头静脉注射 2g 头孢唑林于 100ml 生理盐水内。皮肤切开后立即采集皮下脂肪和关节滑液样本，并通过高效液相色谱法测量头孢唑林浓度。
IO 组关节滑液中的头孢唑林浓度为 391.3±70.1μg/ml，IV 组为 17.6±3.5μg/ml。IO 组的皮下脂肪中的头孢唑林浓度为 247.9±64.9μg/g，IV 组为 11.4±1.9μg/g。
骨内区域性给药比全身给药可实现数倍更高的组织浓度，特别是在关节滑液中。
