人工关节感染翻修术后近期细菌学研究  

Bacteriology after revision and debridement of infected arthroplasty

作　　者：丛锐军[1] 符培亮[1] 刘伟[1] 李晓华[1] 吴海山[1] 吴宇黎[1] 赵辉[1] 王波[1] 

机构地区：[1]第二军医大学长征医院骨科,上海200003

出　　处：《中国骨与关节外科》2013年第1期38-42,共5页Chinese Journal of Bone and Joint Surgery

基　　金：上海市自然基金资助(0941196700)

摘　　要：背景:感染是人工关节置换术后的灾难性并发症,治疗方式尚存争议,疗效不确定。目的:探索人工关节感染翻修术后近期关节和髓腔内细菌的残留情况,为其提供理论依据。方法:制作64只关节置换细菌感染的兔模型,30只为实验组,30只为阴性对照组,4只为备用组。实验组使用中空假体+输液港系统,行二期翻修,术后第1～4周的关节内灌洗液沉渣两等分,一份进行细菌培养,结果作为培养组;另一份使用聚合酶链反应(PCR)方法扩增遗传物质,结果作为PCR组。采用Pearson卡方分析检验翻修术后各时间点培养组和PCR组的组间差异,两两比较卡方分析检验培养组和PCR组不同时间点的时序性差异。结果:实验组动物术后伤口愈合好,术后第1～4周培养组和PCR组阳性率分别为10%、3.33%、3.33%、3.33%和83.33%、40.00%、30.00%、26.67%,细菌学鉴定与植入细菌一致。各时间点培养组阳性率与 PCR 组检出率有统计学差异(χ2=0.27,P=0.605);培养组第 1～4 周的阳性率无统计学差异;PCR 组术后第 1 周的检出率与第 2～4 周比较有统计学差异(P=0.001, 0.000, 0.000),第2～4周的检出率比较无统计学差异。结论:关节翻修术后,细菌在关节腔内的分布非常复杂,一期清创手术应慎重选择;遗传物质的残存作为潜在的危险因素带来临床症状,遗传物质残存在感染复发和细菌变异中的作用值得深入研究。Background： Infection after joint arthroplasty is a devastating complication. The treatment strategy and the therapeutic ef-fect are uncertain. Objective： To explore the status of bacterial remnants in the articular cavity and the medullary space after revision and de-bridement of infected arthroplasty in an attempt to provide theoretical evidence for its treatment. Methods： Animal arthroplasty Staphylococcal aureus infection models were established using 64 experimental rabbits： 30 were used as the experimental group, 30 were used as the negative controls and 4 were used as the spare group. Two-stage revisions were performed with hollow custom-made interval spacer and Portcath. Germiculture and DNA amplification us-ing polymerase chain reaction technique were performed every week after the revision. Two groups of paired count samples were analyzed with Pearson＇s Chi-square test to estimate the coherence of the germiculture and PCR in different time points, and the same methods were used to estimate the difference of the PCR and the germiculture results. Results： The wound healing was achieved well in the experimental group. The positive rate of the germiculture and the PCR was 10%, 3.33%, 3.33% and 3.33%, and 83.33%, 40.00%, 30.00% and 26.67%, respectively. There were significant differences be-tween the germiculture and the PCR in each time point. The differences in the germiculture in week 1-4 were not significant, while the differences in the PCR in the first week were significant compared with that in week 2-4, but no difference in week 2-4. Conclusions： The bacterial distribution after the revision of the infected joint arthoplasty is very complex. One-stage revi-sion should be carefully chosen. The genetic material of bacterial remnants as a potential risk may cause clinical symptoms, and may play a role in the bacterial dissociation and the infection recurrence.

关 键 词：人工关节 假体感染 翻修手术 细菌培养 细菌遗传物质 

分 类 号：R687.4[医药卫生—骨科学]