术中及术后注入次氯酸抢救感染骨科硬体。

Eplasty Pub Date : 2023-01-01
Eric Clayman, Zackery Beauchamp, Jared Troy
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引用次数: 0

摘要

背景:骨科硬体感染通常需要移除或更换硬体。在某些情况下,硬件切除是不可能的或需要截肢。因此,原位硬体修复方法可以显著改善患者的预后。次氯酸是一种广谱抗菌溶液,对生物膜损伤有快速疗效。方法:对2例骨科硬体感染患者进行回顾性分析。患者A在股骨髓内钉处反复出现引流窦。矫形外科小组建议,如果不可能保留硬体,则进行膝以上截肢。患者B右上肢脱手套损伤,桡骨和尺骨骨折,需要血运重建和自由皮瓣覆盖;当硬件感染发生时,硬件移除将需要放置外固定架。两例患者术中清创时均使用次氯酸浸泡硬体5分钟。沿硬体放置封闭吸引管,术后次氯酸通过引流管滴注,每次5分钟,每天1 - 2次,a患者4天,B患者7天。结果:a患者随访10个月,B患者随访9个月,无硬体感染复发迹象。两例患者均成功抢救了硬体。结论:次氯酸是一种安全有效的外用抗菌药物,用于治疗硬件相关生物膜引起的复发性感染。术后通过封闭抽吸引流管滴注0.025%次氯酸可提高硬体抢救率并优化预后。
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Salvage of Infected Orthopedic Hardware With Intraoperative and Postoperative Hypochlorous Acid Instillations.

Background: Orthopedic hardware infections often require hardware removal or replacement. In some situations, hardware removal is not possible or would require amputation. Thus, a method of in-situ hardware salvage could significantly improve patient outcomes. Hypochlorous acid is a broad-spectrum antimicrobial solution with rapid effectiveness in biofilm impairment.

Methods: This article presents 2 patients with orthopedic hardware infection. Patient A had recurrent draining sinuses from an intramedullary nail in the femur. The orthopedic surgery team recommended above-knee amputation if hardware salvage was not possible. Patient B had a degloving injury of the right upper extremity with radius and ulna fractures that required revascularization and free flap coverage; when hardware infection developed, hardware removal would have required external fixator placement. In both patients, hypochlorous acid was used intraoperatively during debridement to soak the hardware for 5 minutes. Closed suction drains were placed along the hardware, and postoperative instillations of hypochlorous acid were placed through the drains for 5 minutes 1 to 2 times a day for 4 days for Patient A and 7 days for Patient B.

Results: On follow-up at 10 months for Patient A and at 9 months for Patient B, there was no evidence of recurrent hardware infection. Hardware was successfully salvaged in both patients.

Conclusions: Hypochlorous acid is an effective and safe topical antimicrobial agent for recurrent infections due to hardware-associated biofilm. Postoperative instillations of 0.025% hypochlorous acid through closed suctions drains may improve hardware salvage rates and optimize outcomes.

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