METHODS: We carried out a search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and identified the studies we needed. Review Manager (RevMan) 5.3 software was employed for statistical analysis.
RESULTS: The analysis of primary TKA (PTKA) showed that using 1 g (RR 0.38, 95% CI 0.22-0.67 [P = 0.0008]) and 2 g (RR 0.48, 95% CI 0.31-0.74 [P = 0.0008]) of vancomycin powder in primary TKA (PTKA) could all significantly prevent PJI. The analysis of primary THA (PTHA) showed that using 1 g (RR 0.37, 95% CI 0.17-0.80 [P = 0.01]) of vancomycin powder effectively decreased the incidence of PJI, while using 2 g (RR 1.02, 95% CI 0.53-1.97 [P = 0.94]) of vancomycin powder had no significant effect on preventing PJI. Because the data were abnormal, we believed the conclusion that using 2 g of vancomycin powder in primary THA had no effect on preventing PJI was doubtful. Using vancomycin powder in revision TKA (RTKA) significantly reduced the PJI rate (RR 0.33, 95% CI 0.14-0.77 [P = 0.01]), similar to revision THA (RTHA) (RR 0.37, 95% CI 0.14-0.96 [P = 0.04]).
CONCLUSIONS: In primary TKA, both 1 g and 2 g of vancomycin powder can effectively prevent PJI. In primary THA, using 1 g of vancomycin powder is a better choice, while the effect of using 2 g of vancomycin powder is not clear, and a more prospective randomized controlled trial should be done to verify it. In revision TKA and revision THA, vancomycin powder is a good choice to prevent PJI.
方法:我们根据系统评价和荟萃分析(PRISMA)指南的首选报告项目进行了搜索,并确定了我们需要的研究。采用ReviewManager(RevMan)5.3软件进行统计分析。
结果:对原发性TKA(PTKA)的分析表明,在原发性TKA(PTKA)中使用1g(RR0.38,95%CI0.22-0.67[P=0.0008])和2g(RR0.48,95%CI0.31-0.74[P=0.0008])万古霉素粉都可以显着预防PJI。原发性THA(PTHA)分析表明,使用1g(RR0.37,95%CI0.17-0.80[P=0.01])万古霉素粉末有效降低了PJI的发生率,而使用2g(RR1.02,95%CI0.53-1.97[P=0.94])万古霉素粉剂对预防PJI无明显作用。因为数据异常,我们认为,在原发性THA中使用2g万古霉素粉末对预防PJI没有效果的结论值得怀疑.在修订TKA(RTKA)中使用万古霉素粉末显着降低了PJI率(RR0.33,95%CI0.14-0.77[P=0.01]),与修订THA(RTHA)相似(RR0.37,95%CI0.14-0.96[P=0.04])。
结论:在初级TKA中,1g和2g万古霉素粉均可有效预防PJI。在初级THA中,使用1克万古霉素粉是更好的选择,虽然使用2克万古霉素粉末的效果尚不清楚,并且应该进行更前瞻性的随机对照试验来验证。在修订TKA和修订THA中,万古霉素粉是预防PJI的好选择。