Bone Joint J：足踝手术前的皮肤消毒效果

　　阿联酋研究人员收集了关于术前皮肤消毒和清洁技术减少足踝皮肤菌群效果的随机和半随机试验，并进行了系统综述及荟萃分析，研究结果近期发表于《骨与关节杂志》（Bone Joint J）。

　　消毒后可培养的细菌群落是主要终点。该研究利用Cochrane协作工具的修正版本对数据进行评估，共评估了符合纳入标准的8项试验（560例受试者，716足）。消毒后可培养细菌数比例在拇趾甲襞（HNF）与趾蹼（TWS）部位存在显著差异：分别为0.47和0.22[95%置信区间（CI）：0.182937～0.304097，P＜0.0001]。

　　荟萃分析表明，HNF部位酒精氯己定比酒精聚维酮碘（PI）具有更好的效果（危险度差0.19 ，95% CI：0.08～0.30，P=0.0005）；在TWS部位利用PI刷洗（scrub and paint）后加酒精处理两步处理法的效果显著优于只用PI刷洗（危险度差0.13，95% CI：0.02～0.24，P=0.0169）；综合HNF和TWS部位，利用酒精氯己定后加酒精处理的两步处理法的疗效显著优于只用PI刷洗（危险度差 0.27 ，95%CI：0.13～0.40，P＜0.0001）。不同清洁技术的效果并未发现显著差异。

Efficacy of preparation solutions and cleansing techniques on contamination of the skin in foot and ankle surgery
A systematic review and meta-analysis
Abstract
We report a systematic review and meta-analysis of published randomised and quasi-randomised trials evaluating the efficacy of pre-operative skin antisepsis and cleansing techniques in reducing foot and ankle skin flora. The post-preparation culture number (Post-PCN) was the primary outcome. The data were evaluated using a modified version of the Cochrane Collaboration’s tool. We identified eight trials (560 participants, 716 feet) that met the inclusion criteria. There was a significant difference in the proportions of Post-PCN between hallux nailfold (HNF) and toe web spaces (TWS) sites: 0.47 vs 0.22, respectively (95% confidence interval (CI) 0.182937 to 0.304097; p < 0.0001).
Meta-analyses showed that alcoholic chlorhexidine had better efficacy than alcoholic povidone-iodine (PI) at HNF sites (risk difference 0.19 (95% CI 0.08 to 0.30); p = 0.0005); a two-step intervention using PI scrub and paint (S&P) followed by alcohol showed significantly better efficacy over PI (S&P) alone at TWS sites (risk difference 0.13 (95% CI 0.02 to 0.24); p = 0.0169); and a two-step intervention using chlorhexidine scrub followed by alcohol showed significantly better efficacy over PI (S&P) alone at the combined (HNF with TWS) sites (risk difference 0.27 (95% CI 0.13 to 0.40); p < 0.0001). No significant difference was found between cleansing techniques.