[1]严坤,张子义,冉建.在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染效果的Meta分析[J].中医正骨,2024,36(02):49-54.
　YAN Kun,ZHANG Ziyi,RAN Jian.Efficacy of rinse with povidone-iodine solution in artificial joint replacement for prevention of postoperative infection:a meta-analysis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2024,36(02):49-54.
点击复制

在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染效果的Meta分析()
分享到：

《中医正骨》[ISSN:1001-6015/CN:41-1162/R]

卷:
第36卷
期数:
2024年02期
页码:
49-54
栏目:
文献研究
出版日期:
2024-02-20

文章信息/Info

Title:
Efficacy of rinse with povidone-iodine solution in artificial joint replacement for prevention of postoperative infection:a meta-analysis
作者:
严坤; 张子义; 冉建
(新疆医科大学第六附属医院,新疆 乌鲁木齐 830002)
Author(s):
YAN Kun; ZHANG Ziyi; RAN Jian
The Sixth Affiliated Hospital of Xinjiang Medical University,Urumqi 830002,Xinjiang,China
关键词:
关节成形术; 置换;  假体相关感染;  外科伤口感染;  聚维酮碘;  专题Meta分析
Keywords:
arthroplasty; replacement;  prosthesis-related infections;  surgical wound infection;  povidone-iodine;  meta-analysis as topic
摘要:
目的:系统评价在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染的效果。方法:应用计算机检索中国知网、万方数据库、PubMed、Embase、Web of Science和Cochrane Library中关于在人工关节置换术中应用聚维酮碘溶液冲洗预防术后感染的对比研究文献,检索时限均为建库至2023年11月1日。试验组术中采用聚维酮碘溶液冲洗,对照组术中采用其他冲洗液冲洗。依据文献检索及筛选方案筛选出符合要求的文献后,由2名研究人员分别独立进行数据提取和质量评价。采用RevMan5.3软件进行Meta分析。结果:共检索到601篇文献,最终纳入14篇,共涉及61 471例患者,其中试验组20 110例、对照组41 361例。2组总感染发生率、假体周围感染发生率、切口延迟愈合或不愈合发生率、二次手术率的组间比较,差异均无统计学意义[OR=0.68,95%CI(0.43,1.07),P=0.090; OR=0.68,95%CI(0.38,1.23),P=0.210; OR=2.08,95%CI(0.73,5.96),P=0.170; OR=1.18,95%CI(0.92,1.51),P=0.200],试验组浅层感染发生率低于对照组[OR=0.52,95%CI(0.30,0.89),P=0.020]。结论:现有证据表明,与其他冲洗液相比,在人工关节置换术中应用聚维酮碘溶液冲洗并不能显著减少术后假体周围感染和切口延迟愈合或不愈合的发生,但能减少术后浅层感染的发生。
Abstract:
Objective:To systematically review the clinical efficacy of rinse with povidone-iodine(PVP-I)solution in artificial joint replacement for preventing postoperative infection.Methods:All the comparative study articles about rinse with PVP-I solution in artificial joint replacement against postoperative infection included from database establishing to November 1,2023 were retrieved from the China National Knowledge Internet,Wanfang Database,PubMed,Embase,Web of Science and Cochrane Library through computer.The patients in experiment group were rinsed with PVP-I solution,while the ones in control group with other flushing solutions in the artificial joint replacement.The articles were screened according to the retrieval and screening scheme.The information was extracted and the methodological quality of included researches in the articles was evaluated independently by two researchers,and then a Meta-analysis was conducted by using RevMan 5.3 software.Results:Six hundred and one articles were searched out.After screening,14 articles(61 471 patients)were included in the final analysis,20 110 patients in experiment group and 41 361 ones in control group.The results of Meta-analysis revealed that the differences in total infection incidence,periprosthetic infection incidence,incision delayed-union or nonunion incidence,and secondary surgery incidence were not statistically significant between the 2 groups(OR=0.68,95%CI(0.43,1.07),P=0.090; OR=0.68,95%CI(0.38,1.23),P=0.210; OR=2.08,95%CI(0.73,5.96),P=0.170; OR=1.18,95%CI(0.92,1.51),P=0.200),while,the superficial infection incidence was lower in experiment group compared to control group(OR=0.52,95%CI(0.30,0.89),P=0.020).Conclusion:Available evidences suggest that rinse with PVP-I solution in artificial joint replacement can not significantly reduce the incidences of postoperative periprosthetic infection and delayed-union or nonunion of incision,but it can reduce the incidence of postoperative superficial infection in contrast to other flushing solutions.

参考文献/References:

[1] KIM C H,KIM H,LEE S J,et al.The effect of povidone-iodine lavage in preventing infection after total hip and knee arthroplasties:systematic review and meta-analysis[J].J Arthroplasty,2020,35(8):2267-2273.
[2] WANG D,HUANG X,LV W,et al.The toxicity and antibacterial effects of povidone-iodine irrigation in fracture surgery[J].Orthop Surg,2022,14(9):2286-2297.
[3] PARVIZI J,SALEH K J,RAGLAND P S,et al.Efficacy of antibiotic-impregnated cement in total hip replacement[J].Acta Orthop,2008,79(3):335-341.
[4] WANG P,WANG D,ZHANG L.Effectiveness of chlorhexidine versus povidone-iodine for preventing surgical site wound infection:a meta-analysis[J/OL].Int Wound J,2023[2023-10-12].https://pubmed.ncbi.nlm.nih.gov/37752735/.
[5] CALKINS T E,CULVERN C,NAM D,et al.Dilute betadine lavage reduces the risk of acute postoperative periprosthetic joint infection in aseptic revision total knee and hip arthroplasty:a randomized controlled trial[J].J Arthroplasty,2020,35(2):538-543.
[6] HERNANDEZ N M,HART A,TAUNTON M J,et al.Use of povidone-iodine irrigation prior to wound closure in primary total hip and knee arthroplasty:an analysis of 11,738 cases[J].J Bone Joint Surg Am,2019,101(13):1144-1150.
[7] FOURNEL I,TIV M,SOULIAS M,et al.Meta-analysis of intraoperative povidone-iodine application to prevent surgical-site infection[J].Br J Surg,2010,97(11):1603-1613.
[8] MOONEY J A,PRIDGEN E M,MANASHEROB R,et al.Periprosthetic bacterial biofilm and quorum sensing[J].J Orthop Res,2018,36(9):2331-2339.
[9] KHEIR M M,TAN T L,ACKERMAN C T,et al.Culturing periprosthetic joint infection:number of samples,growth duration,and organisms[J].J Arthroplasty,2018,33(11):3531-3536.
[10] BERGER V W.Is the Jadad score the proper evaluation of trials?[J].J Rheumatol,2006,33(8):1710-1711.
[11] 曾宪涛,庄丽萍,杨宗国,等.Meta分析系列之七:非随机实验性研究、诊断性试验及动物实验的质量评价工具[J].中国循证心血管医学杂志,2012,4(6):496-499.
[12] HART A,HERNANDEZ N M,ABDEL M P,et al.Povidone-iodine wound lavage to prevent infection after revision total hip and knee arthroplasty:an analysis of 2,884 cases[J].J Bone Joint Surg Am,2019,101(13):1151-1159.
[13] BROWN N M,CIPRIANO C A,MORIC M,et al.Dilute betadine lavage before closure for the prevention of acute postoperative deep periprosthetic joint infection[J].J Arthroplasty,2012,27(1):27-30.
[14] DRIESMAN A,SHEN M,FENG J E,et al.Perioperative chlorhexidine gluconate wash during joint arthroplasty has equivalent periprosthetic joint infection rates in comparison to betadine wash[J].J Arthroplasty,2020,35(3):845-848.
[15] FRISCH N B,KADRI O M,TENBRUNSEL T,et al.Intra-operative chlorhexidine irrigation to prevent infection in total hip and knee arthroplasty[J].Arthroplast Today,2017,3(4):294-297.
[16] HOFMANN K J,HAYDEN B L,KONG Q,et al.Triple prophylaxis for the prevention of surgical site infections in total joint arthroplasty[J].Current Orthopaedic Practice,2017,28(1):66-69.
[17] LUNG B E,LE R,CALLAN K,et al.Chlorhexidine gluconate lavage during total joint arthroplasty may improve wound healing compared to dilute betadine[J].J Exp Orthop,2022,9(1):67.
[18] MATSEN KO L J,YOO J Y,MALTENFORT M,et al.The effect of implementing a multimodal approach on the rates of periprosthetic joint infection after total joint arthroplasty[J].J Arthroplasty,2016,31(2):451-455.
[19] MUWANIS M,BARIMANI B,LUO L,et al.Povidone-iodine irrigation reduces infection after total hip and knee arthroplasty[J].Arch Orthop Trauma Surg,2023,143(4):2175-2180.
[20] SHOHAT N,GOH G S,HARRER S L,et al.Dilute povidone-iodine irrigation reduces the rate of periprosthetic joint infection following hip and knee arthroplasty:an analysis of 31,331 cases[J].J Arthroplasty,2022,37(2):226-231.
[21] SLULLITEL P A,DOBRANSKY J S,BALI K,et al.Is there a role for preclosure dilute betadine irrigation in the prevention of postoperative infection following total joint arthroplasty?[J].J Arthroplasty,2020,35(5):1374-1378.
[22] WINKLER C,DENNISON J,WOOLDRIDGE A,et al.Do local antibiotics reduce periprosthetic joint infections?A retrospective review of 744 cases[J].J Clin Orthop Trauma,2018,9(Suppl 1):S34-S39.
[23] 罗旭,陈伟,韩浩,等.人工关节置换术中碘伏处理创口对预防假体周围感染的临床效果评价[J].中外医学研究,2020,18(22):27-30.
[24] CICHOS K H,ANDREWS R M,WOLSCHENDORF F,et al.Efficacy of intraoperative antiseptic techniques in the prevention of periprosthetic joint infection:superiority of betadine[J].J Arthroplasty,2019,34(7s):S312-S318.
[25] 王利宏,单军标,周方伦,等.聚维酮碘间断灌洗治疗人工关节置换术后早期假体周围感染[J].中华骨科杂志,2020,40(13):840-847.
[26] SEIDELMAN J L,MANTYH C R,ANDERSON D J.Surgical site infection prevention:a review[J].JAMA,2023,329(3):244-252.
[27] FUSE Y,OGAWA H,TSUKAHARA Y,et al.Iodine metabolism and thyroid function during the perinatal period:maternal-neonatal correlation and effects of topical povidone-iodine skin disinfectants[J].Biol Trace Elem Res,2023,201(6):2685-2700.
[28] MARCHIONATTI E,CONSTANT C,STEINER A.Preoperative skin asepsis protocols using chlorhexidine versus povidone-iodine in veterinary surgery:a systematic review and meta-analysis[J].Vet Surg,2022,51(5):744-752.
[29] CHUNDAMALA J,WRIGHT J G.The efficacy and risks of using povidone-iodine irrigation to prevent surgical site infection:an evidence-based review[J].Can J Surg,2007,50(6):473-481.
[30] 步子恒,黄轩,胡宏悻,等.髋关节置换术中碘伏冲洗对患者甲状腺功能的影响[J].中华关节外科杂志(电子版),2019,13(2):151-156.
[31] LABRECQUE S,SHAH S,FERGUS D,et al.Mupirocin susceptibility of staphylococci 2022:is it time for a change in MRSA decolonization protocols?[J]Am J Infect Control,2023,51(7):725-728.

相似文献/References:

[1]邢金明.切开复位锁定钢板内固定术和人工半肩关节置换术 治疗老年肱骨近端复杂骨折的对比研究[J].中医正骨,2015,27(08):11.
　XING Jinming.A retrospective trial of open reduction and locking plate internal fixation versus artificial shoulder hemiarthroplasty for complicated proximal humeral fractures in old patients[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):11.
[2]赵云昌.人工股骨头置换治疗老年粉碎性股骨转子间骨折[J].中医正骨,2015,27(08):31.
[3]张明强.生物型加长柄半髋关节置换术治疗 高龄不稳定股骨转子间骨折疗效观察[J].中医正骨,2015,27(02):56.
[4]蔡云仙.围手术期耳穴按压联合平衡针疗法 在全膝关节置换术后镇痛中的应用[J].中医正骨,2015,27(06):41.
[5]喻长纯,杨明路,王战朝.不同手术方式治疗胫骨平台骨折畸形愈合的体会[J].中医正骨,2015,27(03):37.
[6]魏瑄,宋树春,王金良.术前精确测量和评估在全髋关节置换治疗 成人发育性髋关节发育不良继发骨关节炎中的价值[J].中医正骨,2015,27(01):30.
[7]鲍荣华,陈晓东,王国平,等.Wagner Cone生物型假体置换结合经股骨转子下横形截骨 治疗CroweⅣ型成人发育性髋关节发育不良[J].中医正骨,2015,27(01):33.
[8]喻长纯,杨明路,王战朝.同期髌骨脱位矫正术联合全膝关节置换术治疗 晚期膝骨关节炎合并习惯性髌骨脱位[J].中医正骨,2015,27(01):41.
[9]武理国,沈军,傅国海,等.人工肱骨头置换治疗老年肱骨近端复杂骨折[J].中医正骨,2013,25(10):70.
[10]李国梁,韩广普,闫国强,等.红花化瘀汤薰蒸联合理筋手法 在膝骨关节炎全膝关节置换术后康复中的应用[J].中医正骨,2013,25(12):31.
　Li Guoliang*,Han Guangpu,Yan Guoqiang,et al.Clinical application of HONGHUAHUAYU decoctions steaming combined with sinew adjusting manipulation in the postoperative rehabilitation of total knee arthroplasty in patients with knee osteoarthritis[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2013,25(02):31.
[11]樊庆阳,任凯晶.定制3D打印切模辅助全膝关节置换术治疗 膝骨关节炎合并股骨干骨折畸形愈合[J].中医正骨,2015,27(11):37.
[12]李翰林,童培建.利福平联合用药配合保留假体清创治疗 人工关节置换术后早期感染及低毒性感染[J].中医正骨,2015,27(09):56.
[13]刘晓雅,孙永强,刘国杰.主动快速康复锻炼对全膝关节置换术后关节活动度的影响[J].中医正骨,2015,27(09):73.
[14]张维平,康两期,陈卫,等.全髋关节置换术围手术期隐性失血的研究进展[J].中医正骨,2015,27(08):61.
[15]宋兵华,孙俊英,倪增良,等.全膝关节置换术前CT测量股骨后髁角的临床意义[J].中医正骨,2015,27(07):38.
[16]王金良,孙京涛,李玲,等.骨水泥联合螺钉修复全膝关节置换术中 胫骨平台内侧骨缺损[J].中医正骨,2015,27(12):55.
[17]徐伟锋,叶健,吴连国.强骨饮对骨质疏松性股骨颈骨折患者全髋关节置换术后 血清骨代谢生化指标和骨密度的影响[J].中医正骨,2015,27(02):12.
　XU Weifeng,YE Jian,WU Lianguo.Effect of Qianggu Yin(强骨饮,QGY)on serum bone metabolism indexes and bone density after total hip arthroplasty in patients with osteoporotic femoral neck fractures[J].The Journal of Traditional Chinese Orthopedics and Traumatology,2015,27(02):12.
[18]张荣,王健.人工全膝关节置换术的围手术期心理护理[J].中医正骨,2015,27(05):77.
[19]齐志远,陈秀民,王在斌,等.桃红四物加黄芪汤预防人工髋膝关节置换术后 下肢深静脉血栓形成[J].中医正骨,2015,27(03):71.
[20]陆吴超,季卫锋,马镇川.关节镜下清创后持续灌洗联合中药口服治疗 全膝关节置换术后急性期感染[J].中医正骨,2015,27(01):51.

备注/Memo

备注/Memo:
通讯作者:冉建 E-mail:ranjianxj@126.com
更新日期/Last Update: 1900-01-01