关节置换术后不同拔管时间的引流管尖端细菌培养结果分析

目的 对关节置换术后不同拔管时间负压引流管尖端细菌培养的结果进行临床分析.方法 前瞻性选择行单侧关节置换84例,其中单侧膝关节置换40例,单侧髋关节置换44例.每位患者手术结束时均于切口筋膜层之下放入一根负压引流管,随后立即拔除,引流管尖端约3 cm送细菌培养,此设为对照组.再根据术后拔管时间不同分为两个实验组:24 h组42例,术后24 h拔除;48 h组42例,术后48 h拔除.引流管尖端约3 cm送细菌培养.所有患者术后随访3个月,观察有无发生关节感染.对细菌培养结果及随访结果进行分析.结果 对照组引流管尖端无细菌生长.实验组中24 h组拔除的引流管中有6例(7.14%)细菌培养阳性,其中皮氏罗尔斯顿菌5例(5.95%),大肠埃希菌1例(1.19%);48 h组拔除的引流管中有2例(2.38%)培养阳性,其中皮氏罗尔斯顿菌1例(1.19%),弗劳地枸橼酸杆菌1例(1.19%),24 h组与48 h组细菌培养阳性率比较差异无统计学意义(P>0.05).根据关节置换类型分析,髋关节置换术后拔除的引流管中有5例(5.95%)培养阳性,膝关节置换术后拔除的引流管中有3例(3.57%)培养阳性,两者阳性率比较差异无统计学意义(P>0.05).所有患者随访3个月,均未出现关节感染症状,包括培养阳性的患者.结论 关节置换术后引流管尖端细菌培养结果用来诊断关节感染价值不大,在应用预防性抗生素的情况下,术后48 h内拔管都是安全的.

Clinical analysis of bacterial culture at the tip of negative pressure drainage tube at different extubation time after arthroplasty

Objective To analyze the bacterial culture at the tip of negative pressure drainage tube at different extubation time after ar -throplasty.Methods 84 patients with unilateral arthroplasty were prospectively cultured .Among them,40 cases underwent unilateral knee arthroplasty and 44 cases underwent unilateral hip arthroplasty .At the end of each patient's operation,a negative pressure drainage tube was temporarily placed below the fascia layer ,and then removed immediately,besides,3cm of drainage tube tip for bacterial culture was set as the control group .All the cases were assigned into two experimental groups according to the time after extubation :42 cases in 24-hour group in which the tube was extubated 24h after operation,42 cases in 48-hour group in which the tube was extubated 48h after operation.All the patients were followed up for 3 months after surgery to observe the occurrence of joint infection .The results of bacterial culture and follow-up were analyzed.Results There was no bacterial growth on the tip of the drainage tube in the control group ,but in the experimental group,bacteria appeared on the tip of some drainage tubes .According to the analysis of extubation time ,there were 6 cases (7.14%) with positive bacterial culture in the drainage tube of 24-hour group,among them,there were 5 cases (5.95%) of Ral-stonia pickettii and 1 case (1.19%) of Escherichia coli.In 48-hour group,the drainage tubes of 2 cases (2.38%) were positive,in-cluding 1 case (1.19%) of Ralstonia pickettii,1 cases (1.19%) of Citrobacter freundii;the difference in positive rate between two groups was not statistically significant (P >0.05).According to the analysis of arthroplasty types ,5 (5.95%) of the drainage tubes were positive after unilateral hip arthroplasty ,and 3 (3.57%) of the drainage tubes were positive after unilateral knee arthroplasty ;the difference in positive rate between two groups was not statistically significant (P >0.05).All patients were followed up for 3 months without symptoms of joint infection ,including those with positive cultures .Conclusions Bacterial culture at the tip of the drainage tube after arthroplasty is of little value in the diagnosis of joint infection .In the case of prophylactic antibiotics ,extubation is safe within 48 hours after arthroplasty.