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投稿时间：2024-12-06 网络发布日期：2025-11-26
投稿时间：2024-12-06 网络发布日期：2025-11-26
中文摘要: 目的 探讨全膝关节置换术（TKA）中采用不同剂量万古霉素骨水泥对术后感染的预防效果。方法 前瞻性选取2021年7月至2022年7月邯郸第一医院骨关节科行TKA治疗的患者128例为研究对象，采用随机数字表法分为非抗生素组、0.5 g组、1 g组、2 g组，各32例，所有患者围手术期均采用标准的感染预防方案，非抗生素组用未添加抗生素的骨水泥；0.5 g、1 g、2 g 组分别在 40 g 骨水泥中加入对应剂量万古霉素，以预防术后感染。比较四组患者术后屈膝角度、炎性指标［红细胞沉降率（ESR）、血清C反应蛋白（CRP）］、膝关节功能［美国特种外科医院（HSS）评分］、术后感染及不良反应。结果 0.5 g、1 g及2 g组患者术后屈膝角度大于非抗生素组（P<0.05）；术后24、36、48及72 h，0.5 g组与1 g组患者引流液中万古霉素浓度比较差异无统计学意义（P>0.05）；2 g组患者流液中万古霉素浓度均高于0.5 g组及1 g组（P<0.05）。术后3、7 d，0.5 g、1 g及2 g组患者血清CRP含量、ESR测值均低于非抗生素组（P<0.05），且三个万古霉素组间比较差异无统计学意义（P>0.05）。术后6、12个月，0.5 g、1 g及2 g组患者HSS评分均高于非抗生素组（P<0.05），且三个万古霉素组间比较差异无统计学意义（P>0.05）。术后12个月内，非抗生素组患者出现4例术后感染，万古霉素三组未出现术后感染。结论 万古霉素骨水泥用于TKA，能够降低患者炎症水平，改善膝关节功能，控制感染情况，0.5 g、1 g及2 g万古霉素骨水泥作用效果相似。
Abstract:Objective To investigate the preventive effect of different doses of vancomycin bone cement on postoperative infection in total knee arthroplasty（TKA）. Methods A prospective study was conducted on 128 patients who underwent TKA in the Orthopedics Department of Handan First Hospital from July 2021 to July 2022. They were randomly grouped into a non-antibiotic group，a 0.5 g group，a 1 g group，and a 2 g group using a random number table method，with 32 cases in each group. All patients received a standard perioperative infection prevention protocol. The non-antibiotic group was treated with bone cement without added antibiotics；the 0.5 g，1 g，and 2 g groups received 40 g bone cement mixed with the corresponding dose of vancomycin，respectively，for the prevention of postoperative infection. The postoperative knee flexion angle，inflammatory indicators［erythrocyte sedimentation rate（ESR），serum C-reactive protein（CRP）］，knee joint function［Hospital for Special Surgery（HSS）score］，postoperative infection，and adverse reactions were compared among the four groups. Results The postoperative knee flexion angle of patients in the 0.5 g，1 g，and 2 g groups was greater than that in the non-antibiotic group（P<0.05）. There was no statistically significant difference in the concentration of vancomycin in the drainage fluid between the 0.5 g and 1 g groups at 24，36，48，and 72 h after surgery（P>0.05）. The concentration of vancomycin in the drainage fluid of patients in the 2 g group was higher than that in the 0.5 g and 1 g groups（P<0.05）. The serum CRP levels and ESR values of patients in the 0.5 g，1 g，and 2 g group were lower than those in the non-antibiotic group at 3 d and 7 d after surgery（P<0.05）；and there was no statistically obvious difference among the three vancomycin groups（P>0.05）. At 6 months and 12 months after surgery，the HSS scores of patients in the 0.5 g，1 g，and 2 g vancomycin groups were higher than those in the non-antibiotic group（P＜0.05），and there was no statistically difference among the three vancomycin groups（P>0.05）.Within 12 months after surgery，4 patients in the non-antibiotic group experienced postoperative infections，while the three vancomycin groups did not experience any postoperative infections. Conclusion Vancomycin bone cement for TKA can reduce patients’inflammation levels，improve knee joint function and control infection. The effects of 0.5 g，1 g，and 2 g vancomycin bone cement are similar.
文章编号： 中图分类号：R687.4 R633 文献标志码：A
基金项目:河北省医学科学研究课题计划（20231916）
附件
| 作者 | 单位 |
| 赵志光 | 1. 华北医疗健康集团峰峰总医院邯郸院区关节一科, 河北 邯郸 056001 |
| 韩守江 | 1. 华北医疗健康集团峰峰总医院邯郸院区关节一科, 河北 邯郸 056001 |
| 温振涛 | 2. 邯郸市第一医院骨关节二科, 河北 邯郸 056001 |
| 赵莹 | 3. 邢台医学高等专科学校第二附属医院骨科, 河北 邢台 054002 |
引用文本：
赵志光,韩守江,温振涛,等.不同剂量万古霉素骨水泥在全膝关节置换术中的应用[J].中国临床研究,2025,38(11):1731-1735.
赵志光,韩守江,温振涛,等.不同剂量万古霉素骨水泥在全膝关节置换术中的应用[J].中国临床研究,2025,38(11):1731-1735.