稀释聚维酮碘冲洗在初次髋膝关节置换术中预防假体周围感染的疗效分析

Analysis of the Efficacy of Diluted Povidone Iodine Rinse in Preventing Periprosthetic Infections during Initial Hip and Knee Arthroplasty

摘要: 目的：聚维酮碘冲洗法是一种简单的消毒方法，可降低术后感染风险。然而，该药物能否在全关节置换术后预防假体周围感染的发生尚无临床共识。因此，本研究通过评估聚维酮碘冲洗液在全关节置换术后预防感染的疗效，以期为临床预防人工关节感染提供新的理论依据。方法：回顾性分析2019年9月至2022年10月于新疆医科大学第六附属医院关节外科住院并接受人工髋/膝关节置换术的193例患者，根据术中是否使用稀释聚维酮碘将其进行分组，观察组(稀释聚维酮碘)：96例，对照组(生理盐水)：97例。所有患者随访时间不少于6个月。记录末次随访时的假体周围感染率、浅表感染率、切口不愈合率及二次手术率。结果：观察组与对照组间基线资料的差异无统计学意义(P > 0.05)，具有可比性；观察组术后PJI (P = 0.013)和二次手术(P = 0.009)的发生率明显低于对照组，差异具有统计学意义；而两组间的切口延迟愈合或愈合不良、切口浅层感染的发生率无显著差异(P > 0.05)。结论：我们认为PI能够有效降低TJA术后的PJI和翻修率，并且PI具备和生理盐水类似的安全性。尽管如此，目前现有研究的总体质量仍然很低，需要大型的随机对照试验来明确地回答这些问题。

Abstract: Objective: The povidone iodine flushing method is a simple disinfection method that can reduce the risk of postoperative infection. However, there is no clinical consensus on whether this drug can prevent periprosthetic infections after total joint replacement surgery. Therefore, this study evalu-ates the efficacy of povidone iodine rinse in preventing infection after total joint replacement sur-gery, in order to provide new theoretical basis for clinical prevention of artificial joint infection. Methods: Retrospective analysis of 193 patients who were admitted to the Joint Surgery Depart-ment of the Sixth Affiliated Hospital of Xinjiang Medical University from September 2019 to October 2022 and underwent artificial hip/knee replacement surgery. They were divided into two groups based on whether diluted povidone iodine was used during the surgery. The observation group (di-luted povidone iodine) had 96 patients, while the control group (physiological saline) had 97 pa-tients. All patients will be followed up for no less than 6 months. Record the periprosthetic infection rate, superficial infection rate, incision non healing rate, and secondary surgery rate at the last fol-low-up. Results: There was no statistically significant difference in baseline data between the ob-servation group and the control group (P > 0.05), indicating comparability; The incidence of post-operative PJI (P = 0.013) and secondary surgery (P = 0.009) in the observation group was signifi-cantly lower than that in the control group, and the difference was statistically significant; There was no significant difference in the incidence of delayed or poor healing of incisions or superficial infection between the two groups (P > 0.05). Conclusion: We believe that PI can effectively reduce the PJI and revision rate after TJA surgery, and PI has safety similar to physiological saline. Never-theless, the overall quality of existing research is still very low, and large- scale randomized con-trolled trials are needed to clearly answer these questions.