摘要
骨内局部给药(intraosseous regional administration,IORA)是将骨内输液与止血带技术相结合,利用止血带限制药物在靶肢体的分布,以实现局部组织浓度较全身给药更高的给药方式。近年来,IORA技术在全膝关节置换术(total knee arthroplasty,TKA)中获得了广泛的关注和应用。目前在TKA中主要通过IORA技术给予预防性抗生素。研究证明在TKA术前通过IORA技术给药可以显著提高局部组织的药物浓度。此外,也有研究在TKA中使用IORA技术进行术前镇痛,获得了良好的术后早期镇痛效果。然而,目前尚不明确通过IORA技术给予抗生素是否可有效预防人工关节感染。同时,关于IORA技术是否会增加穿刺点意外、脂肪栓塞等并发症尚存争议。本文通过对TKA中使用IORA技术给药的相关研究进行综述,显示IORA技术在TKA中的应用不会增加并发症发生率,同时可以显著提高局部的药物浓度。在初次TKA中,IORA技术在术后感染预防、疼痛控制等方面可能较传统静脉全身给药方案具有优势。但是,在肥胖、糖尿病以及翻修TKA等感染高危人群中,通过IORA技术给予预防性抗生素的效果尚不明确。
Intraosseous regional administration(IORA)combines intraosseous infusion with tourniquet technology,using the tourniquet to limit the distribution of drugs in the target limb,achieving higher tissue concentration than systemic administration.In recent years,IORA technology has gained widespread attention and application in total knee arthroplasty(TKA).At present,prophylactic antibiotics are mainly administered in TKA by IORA technology.Studies have shown that drug concentration in local tissues can be significantly increased by IORA before TKA.In addition,there are also studies using IORA technology for preoperative analgesia in TKA,and good early postoperative analgesia effect has been obtained.However,it is unclear whether giving antibiotics through IORA technology is effective in preventing artificial joint infections.At the same time,there is still controversy as to whether IORA will increase complications such as puncture site accidents and fat embolism.This study reviews the current research on the use of IORA in TKA and shows that the application of IORA in TKA will not increase the incidence of complications and can significantly increase the local drug concentration.In primary TKA,IORA technology may have advantages over traditional intravenous systemic administration in terms of postoperative infection prevention and pain control.However,the efficacy of prophylactic antibiotics administered through IORA technology is unclear in people at high risk of infection such as obesity,diabetes,and modified TKA.
作者
余沐洋
杨兴东
徐溢明
朱威
翁习生
冯宾
Yu Muyang;Yang Xingdong;Xu Yiming;Zhu Wei;Weng Xisheng;Feng Bin(Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100005,China;Department of Orthopaedics,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100730,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第5期322-328,共7页
Chinese Journal of Orthopaedics
基金
北京市自然科学基金(L232006)
中国医学科学院医学与健康科技创新工程项目(2022-I2M-C&T-B-031)
菲凡补铁——缺铁性贫血诊疗能力提升项目(ffbt-B-2022-005)。
关键词
骨内局部给药
膝关节置换术
有效性
安全性
intraosseous regional administration
total knee arthroplasty
effectiveness
safety
