应用抗生素骨水泥间隔体二期翻修治疗人工全膝关节置换术后迟发感染  

TWO-STAGE REVISION OF INFECTED TOTAL KNEE ARTHROPLASTY USING ANTIBIOTIC-IMPREGNATED ARTICULATING CEMENT SPACER

作　　者：蔡碰德[1] 胡懿郃[1] 谢杰[1] 汪龙[1] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中国修复重建外科杂志》2012年第10期1169-1173,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用抗生素骨水泥间隔体二期翻修治疗人工全膝关节置换术后迟发感染的临床疗效。方法 2007年1月-2009年12月,收治23例(23膝)人工全膝关节置换术后迟发感染患者。男15例,女8例;年龄43～75岁,平均65.2岁。置换术后至出现感染时间为13～52个月,平均17.3个月;发生感染至入院翻修时间为15 d～7个月,平均2.1个月。一期清创、取出假体,植入含庆大霉素抗生素骨水泥间隔体;8～10周感染控制后二期植入假体。分别采用美国特种外科医院(HSS)评分及膝关节学会评分系统(KSS)评价翻修前后患膝功能,并统计总体感染控制率。结果术后患者切口均Ⅰ期愈合。2例二期翻修术后发生再感染,余21例感染控制,总体感染控制率91.3%。患者均获随访,随访时间2～5年,平均3.6年。HSS评分由术前(60.6±9.8)分提高至末次随访时(82.3±7.4)分,KSS评分由术前(110.7±9.6)分提高至末次随访时(134.0±10.5)分,手术前后比较差异均有统计学意义(P<0.01)。X线片复查示假体位置良好,无松动、断裂、假体周围透亮影等异常表现。结论应用抗生素骨水泥间隔体二期翻修能有效控制人工全膝关节置换术后迟发感染,并能较好恢复患膝功能。Objective To investigate the effectiveness of two-stage revision of infected total knee arthroplasty（TKA） using an antibiotic-impregnated articulating cement spacer.Methods The clinical data were analyzed from 23 patients（23 knees） undergoing two-stage revision for late infection after primary TKA between January 2007 and December 2009.There were 15 males and 8 females,aged from 43 to 75 years（mean,65.2 years）.Infection occurred at 13-52 months（mean,17.3 months） after TKA.The time interval between infection and admission ranged from 15 days to 7 months（mean,2.1 months）.One-stage operation included surgical debridement and removal of all knee prosthesis and cement,then an antibioticimpregnated articulating cement spacer was implanted.The re-implantation of prosthesis was performed after 8-10 weeks when infections were controlled.The American Hospital for Special Surgery（HSS） score and Knee Society Score（KSS） were used to compare the function of the knee between pre-and post-revision.The rate of infection control and complication were analyzed.Results All incisions healed primarily.Re-infection occurred in 2 cases after two-stage revision,and infection was controlled in the other 21 cases,with an infection control rate of 91.3%.The patients were followed up 2-5 years（mean,3.6 years）.The HSS score was increased from 60.6 ± 9.8 at pre-revision to 82.3 ± 7.4 at last follow-up,the KSS score was increased from 110.7 ± 9.6 at pre-revision to 134.0 ± 10.5 at last follow-up,all showing signi cant differences（P 0.01）.Radiogrflaphs showed that prosthesis had good position with no loosening,fracture,or periprosthetic radiolucent.Conclusion Two-stage revision using an antibiotic-impregnated articulating cement spacer is an effective method to control infected TKA and to restore the function of a ected knee.

关 键 词：人工全膝关节置换术 迟发感染 二期翻修术 抗生素骨水泥间隔体 

分 类 号：R687.4[医药卫生—骨科学]