抗生素骨水泥降低全膝關節置換手術病人深部感染之成效

Efficacy of Antibiotic-Loaded Bone Cement for the Risk of Deep Infections in Total Knee Arthroplasty

深部感染是全膝關節置換術術後的嚴重併發症之一，會導致住院天數延長及醫療成本增加，而抗生素骨水泥廣泛地使用在重置的感染性關節手術，近年來亦被使用在初次關節置換手術的病人上，但此作法於臨床上並無一致性，且缺乏大型隨機性研究證據支持，成效不一。目前相關研究證實，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。因此本研究目的為以系統性文獻回顧法，探討抗生素骨水泥降低膝關節置換手術深部感染之成效。搜尋2007年至2019年發表之中英文文獻，資料庫包括：CINAHL、Cochrane Library、PubMed／MEDLINE及華藝線上圖書館等，關鍵字分別為：全膝關節置換手術、抗生素骨水泥、深部感染、primary total knee arthroplasty、antibiotic-loaded bone cement、deep infection。文獻選取符合條件為抗生素骨水泥為介入措施，對全膝關節置換手術後深部感染之隨機控制試驗或世代研究，並以Critical Appraisal Skills Programme（CASP）作為品質評估工具，共納入5篇文章，分別為4篇回溯性世代研究及1篇隨機控制試驗。系統結果顯示深部感染發生率為0.4－2.2％，抗生素骨水泥組並無降低全膝關節置換術病人術後深部感染率。此篇系統性文獻回顧指出，預防性使用抗生素骨水泥無法明顯降低全膝關節置換術病人術後深部感染率，建議未來研究朝向更為嚴謹、大規模的隨機控制試驗，以持續更新此實證結果。

Deep infection (DI) is a catastrophic complication of total knee arthroplasty (TKA). Antibiotic-loaded bone cement (ALBC) has been extensively used for the treatment of infected revision arthroplasty. However, the routine use of ALBC during primary or uninfected revision arthroplasty remains debatable. Therefore, this systematic review assessed the antimicrobial efficacy and safety of ALBC for its prophylactic use in TKA. We searched four English/Chinese databases, including the Airiti Library, Cumulative Index to Nursing and Allied Health, Cochrane Library, and PubMed/ MEDLINE, for original articles published between 2007 and 2019. Five papers published between 2009 and 2014 were included in the final analysis. We used the PRISMA methodology to process one randomized controlled trial (RCT) and four retrospective cohort studies. The study quality was assessed using the Jadad scale (8 points). Furthermore, two appraisers independently reviewed each study using the standardized critical appraisal tools from the Critical Appraisal Skills Programme. Five studies fulfilled the inclusion criteria. Overall, the incidence of DI was 0.4% - 2.2%. ALBC did not decrease the incidence of DI following TKA. This systematic review showed that the prophylactic use of ALBC did not markedly decrease the risk of DI in TKA. Nevertheless, more RCTs are warranted to further determine the efficacy and safety of ALBC for TKA.