291例人工关节置换术后无感染的临床经验

目的探讨6年内行291例人工关节置换术无一例感染的临床经验。方法追踪分析该院6年内已进行的312侧人工关节置换术患者术前、术中和术后预防感染的评估方法、措施和观察方法。291例312侧人工关节置换术,髋关节置换术257例侧,骨肿瘤型人工髋关节置换术6例,膝关节置换术41例,人工肱骨头置换术7例,掌指关节置换术1例。结果追踪时间1个月至6年,平均2年4个月。伤口甲级愈合311例,拆线时间8～15d,平均13.6d。术后切口区红肿而用酒精或希安尔碘敷料湿敷为36例侧(占11.54%),切口肿胀哆开或皮缘颜色变暗而拆除1～2条缝线者4例(占1.28%),其中1例4周后乙级愈合。结论预防人工关节置换术感染以无菌术最重要,适当预防性使用抗生素次之。

Clinical research of 312 artificial prosthetic replacements of joints without infection in six years

Objective To investigate the clinical experience of 312 prosthetic replacements without infection in our hospital in 6 years. Methods 312 patients were treated by joint replacement in 6 years, The evaluation of infection and measures to prevention infection during the surgery were studied by a follow-up survey. There were 129 males and 183 females with an average age of 62.53 years (range, 17 to 98 years). There were 257 hip replacements, 6 bone tumor artificial hip replacements, 41 total knee replacements, 7 artificial humeral head replacements and one metacarpophalangeal joint replacement. Results The follow-ups lasted from one month to 6 years with an average of 28 months. 311 surgery wounds accrete at the first grade. The suture-out time was from 8 to 15 days (average 13.6 days). 36 cases(11.54%) were hydropathic compressed postoperatively by alcohol and iodine dressing because of incision flare. 4 cases had 1 or 2 suture demolished because of incision flaring to carat or darkened skin edge, one of which accreted at the second grade after 4 weeks. Conclusions Aseptic technique is of most importance in the infect-precaution after joint replacement. Appropriate use of prophylactic antibiotics is less important.