一期全髋关节置换术中局部使用万古霉素粉剂：一项前瞻性质量控制研究。
Intrawound Vancomycin Powder in Primary Total Hip Arthroplasty: A Prospective Quality Control Study.
机构信息
Department of Orthopaedic Surgery, TRIA Orthopaedic Institute, Bloomington, Minnesota; Department of Orthopaedic Surgery, Park Nicollet Methodist Hospital, St. Louis Park, Minnesota.
Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota.
出版信息
J Arthroplasty. 2024 Sep;39(9S2):S327-S331. doi: 10.1016/j.arth.2024.03.063. Epub 2024 Apr 9.
BACKGROUND
The purpose of this retrospective analysis of a prospective quality control project was to determine whether the use of intrawound vancomycin powder (IVP) decreases the rate of periprosthetic joint infection (PJI) within 90 days following primary total hip arthroplasty (THA).
METHODS
From October 2021 to September 2022, a prospective quality control project was undertaken in which 10 high-volume THA surgeons alternated between using and not using IVP each month while keeping other perioperative protocols unchanged. A retrospective analysis of the project was performed to compare the group of patients who received IVP to the group of patients who did not. The primary outcome was a culture positive infection within 90 days following primary THA. Secondary outcomes included gram-positive culture, overall reoperation rate, wound complications, readmission, and wound complications within 90 days post-operatively. A total of 1,193 primary THA patients were identified for analysis. There were 523 (43.8%) patients who received IVP and were included in the IVP group, while 670 (56.2%) did not and were included in the non-IVP group. Age, body mass index, and sex were similar between the 2 groups (P > .25).
RESULTS
The IVP group had a higher rate of culture positive joint infections (1.7 [0.8, 3.2] versus 0.3% [0.04, 1.1], P = .01) than the non-IVP group. All PJI's were found to have gram positive bacteria in both groups. The IVP group had a higher overall reoperation rate than the non-IVP group (6.1 [4.2, 8.5] versus 2.4% [1.4, 3.9], P < .01). The IVP group had a higher reoperation rate for any wound complication compared to non-IVP patients (2.7 [1.5, 4.5] versus 0.7% [0.2, 1.7], P < .01). The overall readmission rate (6.1 [4.2, 8.5] versus 2.8% [1.7, 4.4], P < .01), as well as readmission for suspected infection (2.1 [1.1, 3.7] versus 0.6% [0.02, 1.5], P = .03), were higher in the IVP group.
CONCLUSIONS
The use of IVP in primary THA was associated with a higher rate of PJI, overall reoperation, reoperation for wound complications, and readmission in a prospective quality control project. Until future prospective randomized studies determine the safety and efficacy of IVP in THA conclusively, we advocate against its utilization.
背景
本回顾性分析是一项前瞻性质量控制项目的一部分，旨在确定在初次全髋关节置换术（THA）后 90 天内使用局部万古霉素粉末（IVP）是否会降低假体周围关节感染（PJI）的发生率。
方法
从 2021 年 10 月至 2022 年 9 月，10 名高容量 THA 外科医生在每个月交替使用和不使用 IVP，同时保持其他围手术期方案不变。对该项目进行回顾性分析，比较接受 IVP 的患者组和未接受 IVP 的患者组。主要结局是初次 THA 后 90 天内培养阳性感染。次要结局包括革兰阳性培养、总再次手术率、伤口并发症、再入院和术后 90 天内的伤口并发症。共确定了 1193 例初次 THA 患者进行分析。523 例（43.8%）患者接受 IVP 并纳入 IVP 组，670 例（56.2%）未接受 IVP 并纳入非 IVP 组。两组患者的年龄、体重指数和性别相似（P >.25）。
结果
IVP 组的培养阳性关节感染率高于非 IVP 组（1.7%[0.8%，3.2%]比 0.3%[0.04%，1.1%]，P =.01）。两组均发现所有 PJI 均为革兰阳性菌。IVP 组的总再次手术率高于非 IVP 组（6.1%[4.2%，8.5%]比 2.4%[1.4%，3.9%]，P <.01）。与非 IVP 患者相比，IVP 组的任何伤口并发症的再次手术率更高（2.7%[1.5%，4.5%]比 0.7%[0.2%，1.7%]，P <.01）。IVP 组的总再入院率（6.1%[4.2%，8.5%]比 2.8%[1.7%，4.4%]，P <.01）以及疑似感染再入院率（2.1%[1.1%，3.7%]比 0.6%[0.02%，1.5%]，P =.03）均高于非 IVP 组。
结论
在初次 THA 中使用 IVP 与 PJI、总再次手术、伤口并发症再次手术和前瞻性质量控制项目中的再入院率较高相关。在未来的前瞻性随机研究明确 IVP 在 THA 中的安全性和有效性之前，我们不主张使用 IVP。
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