抗生素骨水泥使用於關節置換手術之效益及文獻回顧

Efficacy of Antibiotic-loaded Bone Cement Use in Total Joint Arthroplasty

隨著人口老化及壽命延長，台灣每年接受人工關節置換手術的病患日益增加。抗生素骨水泥廣泛地使用在重置的感染性關節手術中，近年來亦被使用在初次關節置換手術的病人上，但此作法缺乏相關大型隨機性研究證據支持。目前相關研究顯示抗生素骨水泥用於全髖關節置換手術及感染性關節炎可降低感染風險機率，但於全膝關節置換手術中並無明顯優勢。至於抗生素種類的選擇、使用劑量以及是否併用不同種類抗生素等目前亦無定論，部分研究指出 gentamicin 是不錯且具廣效抗菌能力的選項。然而使用抗生素骨水泥亦有一定程度風險，臨床醫師需謹慎考量利弊，配合術前針劑預防性抗生素、增進手術技術及遵守手術相關感染管制措施，方能降低術後感染率。 The prevalence of joint replacement surgery is on the rise in Taiwan as the population is aging and life expectancy is increasing. The use of antibiotic-loaded bone cement (ALBC) is an established method in the management of periprosthetic hip and knee joint infections. ALBC has also been used in primary joint replacement surgery in recent years, which is not yet established by a large randomized controlled trial. Some research results reported a lower risk of infection when ALBC was used in total hip joint replacement and periprosthetic joint infection cases. There is no benefit of using ALBC in total knee joint replacement. There is no conclusion in determining which choice of antibiotic is better than the others. However, few studies have reported that gentamicin may be effective. Regarding ALBC-associated risks, clinicians should consider both the benefits and drawbacks of using ALBC. Systemic prophylaxis antibiotics, improvement in procedural skills, and complying with the policy of infection control are the gold standard to decrease infection rates.

The prevalence of joint replacement surgery is on the rise in Taiwan as the population is aging and life expectancy is increasing. The use of antibiotic-loaded bone cement (ALBC) is an established method in the management of periprosthetic hip and knee joint infections. ALBC has also been used in primary joint replacement surgery in recent years, which is not yet established by a large randomized controlled trial. Some research results reported a lower risk of infection when ALBC was used in total hip joint replacement and periprosthetic joint infection cases. There is no benefit of using ALBC in total knee joint replacement. There is no conclusion in determining which choice of antibiotic is better than the others. However, few studies have reported that gentamicin may be effective. Regarding ALBC-associated risks, clinicians should consider both the benefits and drawbacks of using ALBC. Systemic prophylaxis antibiotics, improvement in procedural skills, and complying with the policy of infection control are the gold standard to decrease infection rates.