初次全膝关节置换术抗生素骨水泥应用的回顾性队列研究

目的回顾性分析初次全膝关节置换术的合适病例,探讨抗生素骨水泥的应用是否可以降低其术后感染率。方法对1994年至2009年本组所有接受初次全膝关节置换术的患者按是否使用抗生素骨水泥分为两组,分析年龄、性别、BMI、糖尿病、基础疾病、HSS评分、手术时间的差别,对其中的差异项目进行Logistic回归分析以找出影响TKA术后感染的因素,并对感染病例进行感染时问、致病菌、药敏结果等分析。结果抗生素骨水泥组相比于非抗生素骨水泥组,其感染率方面并无统计学差异（8／945vs5／701,x^2=0．0913,P〉0．05）。相关性Logistic回归分析显示抗生素骨水泥应用并不能降低感染率[OR=1．241,95％CI（0．402,3．834）,x^2=0．140,P〉0．05]。13例感染病例分析表明,凝固酶阴性葡萄球菌（CNS）占38％,传统的金黄色葡萄球菌（SA）仅占23％,临床常用的庆大霉素骨水泥无法完全覆盖。结论对抗生素骨水泥的使用仍应保持审慎的态度,避免过度使用造成的医疗资源浪费以及抗生素相关并发症发生率的增加。

A retrospective cohort study on prophylactic use of antibiotic-loaded bone cement in primary total knee arthroplasty

Objective To confirm whether antibiotic-loaded bone cement （ALBC） may reduce infection rates of primary total knee arthroplasty （TKA） by a retrospective cohort study. Methods All cases of primary TKA from 1994 to 2009 were divided into two groups based on whether received ALBC. Differences of age, BMI, diabetes, HSS score and operation time were compared. Logistic analysis was perfot~ned to confirm the factors causing infection. Further analysis of all infection cases was also performed. Results The rates of infection between ALBC group and non-ALBC group had no difference （8/945 vs 5/701, Z2 =0.0913, P 〉0.05）. The result of logistic analysis also showed ALBC was not predictive of a lower incidence of infection （ OR = 1. 241, 95% C1 （0. 402, 3. 834） , （ x^2= 0. 140, P 〉 0 05）. Further analysis of 13 infection cases showed coagulase-negative staphylococcus （CNS） was most prevalent （38%）, while traditional staphylococcus aureus （SA） was only 23%. The commonly used antibiotic gentamicin may not cover the entire spectrum of organisms. Conclusions A prudential attitude should be held on prophylactic use of ALBC to avoid overuse which may cause waste of medical resources and increase frequency of related complications.