Gillespie W J
Department of Orthopaedic Surgery, University of Edinburgh, Scotland.
Clin Infect Dis. 1997 Dec;25(6):1310-7. doi: 10.1086/516134.
Prophylactic antimicrobial regimens providing adequate drug levels in tissue during surgery and for periods of 24 hours to 14 days are of proven effectiveness in reducing infection rates after joint arthroplasty. Although most surgeons employ short regimens of < 24 hours' duration, their efficacy has not been clearly established for joint replacement in placebo-controlled trials. Careful preparation of the patient before surgery and attention to operating room asepsis are also important. In early postoperative infections, surgical debridement and antibiotic treatment may allow conservation of the prosthetic components. In established infection in which the components have become loose, radical surgical debridement must include removal of all prosthetic material as well as involved bone and soft tissue; reconstruction by exchange arthroplasty has an acceptable success rate. For infections caused by organisms of low virulence, exchange arthroplasty has been successful as a one-stage procedure, but no comparative trial with two-stage exchange has yet been reported.
预防性抗菌方案在手术期间及术后24小时至14天内可在组织中提供足够的药物浓度，已证实其在降低关节置换术后感染率方面有效。尽管大多数外科医生采用持续时间小于24小时的短期方案，但在安慰剂对照试验中，其对关节置换的疗效尚未明确确立。术前对患者的精心准备以及对手术室无菌操作的关注也很重要。在术后早期感染中，手术清创和抗生素治疗可能有助于保留假体部件。在假体部件已松动的确诊感染中，根治性手术清创必须包括去除所有假体材料以及受累的骨和软组织；通过翻修置换术进行重建有可接受的成功率。对于由低毒力微生物引起的感染，一期翻修置换术已成功应用，但尚无与二期翻修置换术的对比试验报道。
