局部应用万古霉素粉末预防膝和髋关节置换术后手术部位感染有效性和安全性的meta分析

Meta-analysis of Efficacy and Safety of Intrawound Vancomycin Powder for Preventing Surgical Site Infections in Total Knee and Total Hip Arthroplasty

关键词:  全膝关节置换  全髋关节置换  万古霉素  假体周围感染  meta分析

Key words:  total knee arthroplasty  total hip arthroplasty  vancomycin  prosthetic joint infection  meta-analysis

摘要:

目的 系统评价局部应用万古霉素粉末预防膝和髋关节置换术后手术部位感染的有效性和安全性。方法 计算机检索PubMed、Embase、Web of Science、the Cochrane Library、中国知网、万方数据库、中国生物医学文献数据库，筛选局部应用万古霉素预防膝和髋关节置换术后手术部位感染的临床研究，应用Cochrane风险偏倚评估工具和纽卡斯尔-渥太华量表评估纳入文献的质量，使用RevMan 5.4软件进行meta分析。结果 最终纳入20篇文献，共34 900例患者，包括1项前瞻性随机对照研究、2项前瞻性队列研究、17项回顾性队列研究。Meta分析结果显示，与对照组相比，局部应用万古霉素粉末的试验组能够降低术后假体周围感染(prosthetic joint infection，PJI)的总体发生率[OR=0.44，95%CI(0.35~0.56)，P<0.000 01)]，浅表感染的总体发生率[OR=0.27，95%CI(0.19~0.41)，P<0.000 01]。进一步依据手术部位(膝关节和髋关节)、手术方式(初次和翻修)的不同进行亚组分析，结果显示，试验组的PJI发生率均低于对照组，差异均有统计学意义(P<0.05)。有11篇文献报道了不良反应，试验组的总体不良反应发生率(7.68%)高于对照组(5.68%)，差异有统计学意义[OR=1.47，95%CI( 1.14~1.89)，P=0.003]。结论 现有证据提示，局部应用万古霉素粉末能够降低初次和翻修的膝和髋关节置换术后PJI和浅表感染的发生率，但也可能增加切口无菌性并发症等不良反应的风险。

Abstract:

OBJECTIVE To systematically evaluate the efficacy and safety of intrawound vancomycin powder for preventing surgical site infections in total knee and total hip arthroplasty. METHODS Computer retrieval of PubMed, Embase, Web of Science, the Cochrane Library, CNKI, Wanfang Database, Chinese Biomedical Literature Database, The clinical research about intrawound vancomycin in total knee arthroplasty(TKA) and total hip arthroplasty(THA) for the prevention of surgical site infections were screened. The quality of included studies was assessed using the Cochrane risk bias assessment tool and the Newcastle-Ottawa Scale. Meta-analysis was performed using RevMan 5.4 software. RESULTS Finally, 20 literature were included, including 1 prospective randomized controlled trial, 2 prospective cohort study, and 17 retrospective cohort study, with a total of 34900 patients. Meta-analysis showed that interventional group had a decreased tolal rate of prosthetic joint infection(PJI)[OR=0.44, 95%CI(0.35-0.56), P<0.000 01] and superficial infection[OR=0.27, 95%CI(0.19-0.41), P<0.000 01]compared with control group. Subgroup analysis showed that TKA and THA, primary and revision patients who received intrawound vancomycin had lower rates of PJI, the differences were statistical significance(P<0.05). Meta-analysis of 11 studies reported adverse reaction suggested that the total rate of adverse reactions in the intervention group(7.68%) was higher than that in the control group(5.68%) with significant differences[OR=1.47, 95%CI(1.14-1.89), P=0.003)]. CONCLUSION The current literature suggests that intrawound vancomycin can decrease the rate of PJI and superficial infection in primary and revision TKA and THA , however, it may increase risk of aseptic wound complications and other adverse reaction.