Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction
Vancomycin pre-soaking of the graft reduces postoperative infection rate without increasing risk of graft failure and arthrofibrosis in ACL reconstruction
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DOI：
10.1007/s00167-018-5323-6
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发表时间：
2019-09-01
影响因子：
3.8
通讯作者：
Hoeher, Juergen
中科院分区：
文献类型：
--
作者：
Offerhaus, Christoph;Balke, Maurice;Hoeher, Juergen
目的 探讨在前交叉韧带重建 (ACLR) 期间将移植物预浸泡在万古霉素中是否会降低术后感染率，以及该技术是否会增加并发症发生率，包括移植物失败或关节纤维化。方法对前瞻性数据库进行回顾性分析，纳入 1779 例 5 年以上接受 ACLR 的患者，分析术后膝关节深部感染的发生率。第 1 组和第 2 组均接受围手术期静脉注射抗生素，而仅第 2 组接受 ACLR，并将移植物预浸泡在 5 mg/ml 万古霉素溶液中。为了分析与使用万古霉素相关的可能副作用，从整个研究人群中随机选择了 500 名患者（每年 100 名患者），并进行回顾性访谈，了解进一步的术后并发症，包括移植失败和关节纤维化，并通过完成 IKDC 表格对膝关节进行主观评估，平均随访时间最短为 37 个月。结果 在第 1 组中，926 名患者中有 22 名（2%）发生术后深部膝关节感染。相比之下，第二组 853 名患者没有出现术后感染（0%）。 22 例感染中有 16 例 (73%) 由凝固酶阴性葡萄球菌引起。统计分析显示，用万古霉素浸泡自体移植物后，术后感染率显着降低（p < 0.01）。随机样本分析显示，万古霉素组 257 名患者 (3%) 中移植失败率显着降低，其中 8 例再断裂，而对照组 167 名患者 (10%) 中移植失败 16 例 (p < 0.05)。术后关节纤维化发生率、Tegner 评分或主观结果评分没有差异。结论 与单独使用全身抗生素相比，ACLR 期间预防性万古霉素预浸泡自体移植物似乎是降低深部感染率的可行、经济有效且安全的选择。
Purpose To investigate whether pre-soaking the graft in vancomycin during anterior cruciate ligament reconstruction (ACLR) reduces the postoperative infection rate and if this technique is associated with an increased rate of complications, including graft failure or arthrofibrosis. Methods A retrospective review of a prospective database was performed in 1779 patients who underwent ACLR over a period of 5 years, analysing the rate of postoperative deep knee infection. Group 1 and 2 both received perioperative IV antibiotics, while only group 2 underwent ACLR with grafts pre-soaked in a 5 mg/ml vancomycin solution. To analyse possible side effects associated with vancomycin use, 500 patients out of the overall study population (100 patients per year) were randomly selected and retrospectively interviewed for further postoperative complications including graft failure and arthrofibrosis as well as subjective evaluation of their knee by completing the IKDC form with a minimum mean follow-up of 37 months. Results In group 1, 22 out of 926 (2%) patients suffered a postoperative deep knee infection. In contrast, there were no postoperative infections in the second group of 853 patients (0%). 16 of 22 infections (73%) were caused by coagulase-negative Staphylococcus. Statistical analysis revealed a significantly reduced postoperative infection rate when bathing the autograft in vancomycin (p < 0.01). Analysis of the random sample revealed a significant decrease of graft failure with 8 reruptures in 257 patients (3%) in the vancomycin group compared to 16 cases of graft failure in 167 patients (10%) in the control group (p < 0.05). No differences were found in the rate of postoperative arthrofibrosis, Tegner or subjective outcome scores. Conclusion Prophylactic vancomycin pre-soaking of autografts during ACLR appears to be a viable, cost-effective and safe option to reduce the rate of deep infection compared to systemic antibiotics alone.