皮质类固醇注射在整形外科手术中的机制和安全性
Jonathan J Light1, Mitchell P John2, Kevin F Bonner3
1Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York.
JBJS reviews
|February 12, 2025
概括
皮质类固醇注射 (CSI) 可以缓解肌肉骨疾病的疼痛,但可能会增加手术部位感染的风险,特别是在手术前进行多次注射时. 由于研究设计的多样化,确定安全的术后时间表仍然具有挑战性.
科学领域:
- 整形外科手术 整形外科手术
- 肌肉骨医学 肌肉骨医学
- 药理学 药理学是指药理学的学科.
背景情况:
- 皮质类固醇注射 (CSI) 广泛用于治疗骨关节炎和炎症肌肉骨疼痛.
- 它们具有诊断和治疗作用,可以缓解痛风,足底带炎和神经瘤等疾病的暂时疼痛.
- 在外科手术之前,CSI经常被用作非手术治疗.
研究的目的:
- 审查现有的关于与皮质类固醇注射相关的外科手术期间感染风险的文献.
- 确定与手术相关的CSI时间制定标准化建议的挑战.
- 突出需要基于证据的指导方针,关于安全的外科手术期间CSI管理.
主要方法:
- 系统审查各种整形外科子专业的研究.
- 在CSI后分析有关外科手术期间感染风险的数据.
- 评估研究设计和患者群体异质性.
主要成果:
- 中枢神经干扰可以为肌肉骨疾病提供显著的疼痛缓解.
- 有可能增加手术部位感染的风险,与细菌污染和皮质类固醇免疫调节有关.
- 在手术后的一年内发生多次CSI可能会增加某些关节的感染风险.
结论:
- 虽然CSI对疼痛管理有好处,但由于感染风险,其术后使用需要仔细考虑.
- 研究中的异质性使得建立安全的外科手术期间CSI时间的最终指南变得复杂.
- 需要进一步的高质量证据来确定外科手术期间CSI的非显著感染风险时间表.
相关概念视频
Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
215
Inhaled corticosteroids (ICS) are anti-inflammatory drugs used primarily in treating persistent asthma and providing long-term maintenance. They target the bronchial mucosa, the lining of the airways, to control inflammation, a critical factor in asthma progression and exacerbation.
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
215
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
94
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
94
Drug Delivery: Miscellaneous Routes
305
Drug delivery methods like oral inhalation, nasal sprays, transdermal patches, eye drops, intravitreal injection, and rectal administration provide localized effects with reduced toxicity.
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs...
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs...
305
Skeletal Muscle Relaxants: Adverse Effects
332
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
332
Skeletal Muscle Relaxants: Therapeutic Uses
462
Skeletal muscle relaxants are used to relax muscle tone and alleviate painful muscle contractions. However, the choice of skeletal muscle relaxants depends on the duration of the surgical procedure in order to minimize potential side effects. Skeletal muscle relaxants like neuromuscular blocking agents [NMBAs] are commonly employed as adjuvants alongside general anesthetics in clinical settings. NMBAs are also used to maintain controlled ventilation during surgery of the larynx or pharynx...
462


