关节更换手术即将应用防感染新方法

A rinsing¹（清水，残渣） technique with betadine that costs just a little over one dollar per patient may significantly reduce the infection rate following total knee and hip² joint³ replacement⁴ surgery according to a study by researchers at Rush University Medical Center. The study, presented at the American Association of Orthopedic（整形外科的） Surgeons 2011 Annual Meeting, found that a three minute diluted⁵（稀释的） betadine lavage combined with painting of the skin with a 10% betadine solution prior to surgical⁶ closure nearly eliminated early deep post-operative infection.

Deep periprosthetic joint infection is a rare but devastating⁷ complication associated with total joint replacement. Despite aseptic（无菌的） techniques, careful skin preparation and prophylactic⁸（预防疾病的） antibiotics⁹, deep infections still occur with a prevalence ranging from 0.3% to 1.9%.

Previous research has shown that a diluted betadine lavage of the surgical wound prior to closure reduces the rate of post-operative infection in orthopedic, urologic, cardiovascular and general surgery but it has not been previously¹⁰ studied in total joint arthroplasty（关节成形术） .

"Betadine is safe, inexpensive, simple to use, and readily available within most operating rooms," said study author Dr. Craig Della Valle, associate professor of orthopedic surgery at Rush. "In addition, betadine is effective on many types of bacteria including methicillin-resistant Staphylococcus Aureus (MRSA).

Researchers implemented¹¹ a protocol¹² for primary total knee and total hip arthroplasty in which the wound is soaked with the diluted betadine solution for three minutes following implantation of the prosthetic components¹³. This is followed by a pulsating¹⁴ lavage of normal saline without antibiotics. Prior to final closure, betadine is applied¹⁵ to the skin surrounding the incision¹⁶（切口，雕刻） . Prior to this protocol, wounds were lavaged with normal saline only.

Acute post-operative deep infection was diagnosed in 18 out of the 1862 cases performed prior to the initiation¹⁷ of the betadine lavage protocol and in only one of the 688 total joint arthroplasties following initiation of this protocol; a reduction of the infection rate from 0.97% to 0.15%. There were no side complications associated with the treatment.

The study authors caution there are some limitations to the study. Changes in the surgeon's technique occurred over the time of the study, and it was not feasible（可行的） to determine the impact of these changes on the rate of infection. These included variations in the incision size, suture（缝合） material, and type of skin sealant（密封剂） .