原假体回植用于膝关节置换术后感染翻修的临床观察  

Clinical observation of original prostheses re-implantation for treatment of periprosthetic infection after total knee arthroplasty

作　　者：黄旭胜 王健[1] 肖军[1] 赵亮[1] 史占军[1] 

机构地区：[1]南方医科大学南方医院关节与骨病外科,广州510515

出　　处：《中华关节外科杂志（电子版）》2017年第5期83-87,共5页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的探讨原假体回植作为间隔物的非常规一期翻修对全膝关节置换术后感染的治疗效果。方法本研究回顾性分析了2008年5月至2016年6月收住于南方医院关节与骨病外科的全膝关节置换术后感染患者11例,采用非常规一期翻修的治疗手段,一期手术彻底清创后将消毒后的股骨假体、胫骨假体和新内衬作为关节间隔物,待感染控制后根据患者意愿决定是否行二期翻修手术,评估两次翻修术后关节活动和感染控制情况,术前术后膝关节活动度评分的比较采用配对t检验。结果平均随访时间为(18±13)个月(6~45个月)。全部患者一期手术后均可带引流管下地行走,术后5 d活动范围均可达到90°。一期手术后只有1例患者进行了二期手术安装永久性假体,1例患者在一期手术后1年再次发生关节感染,按上述方法取出假体后再次使用原假体做间隔物翻修,术后无感染复发迹象,该患者拒绝置入新假体。其余9例患者均拒绝行二期手术。9例患者中3例活动时有轻微疼痛,余6例基本无疼痛。一期手术前和手术后患者关节活动度分别为(62±30)°(10°~100°)、(104±9)°(90°~120°)(t=4.659,P<0.01),感染控制率为90.9%。结论原假体回植作为间隔物的非常规一期翻修术治疗全膝关节置换术后假体周围感染拥有良好的临床效果和应用前景。Objective To explore the efficacy of the original prostheses re-implantation as spacer for the treatment of periprosthetic infection after total knee arthroplasty. Methods A retrospective study was conducted in 11 patients with periprosthetic infection after total knee arthroplasty in orthopedics department of Nanfang Hospital from May 2008 to June 2016. The patients were treated with an unconventional one-stage revision procedure. At the first-stage surgery,the disinfectant femur component,tibial component and new liner were re-implanted in the joint after a thorough debridement. The secondstage revision was performed according to patients ＇ intension. The patients were evaluated based on the range of motion and re-infection rate. The pre-operative and post-operative range of motion were calculated by paired t test. Results The mean duration of follow-up was（ 18 ± 13） months（ 6-45 months）. After the first-stage surgery,all the patients were able to walk with drainage. Five days after the first-stage surgery,the range of motion was able to reach 90°. One patient got periprosthetic infection one year after the first-stage surgery. Again,the disinfectant femur component,tibial component and a new liner were reimplanted in the joint and there was no sign of recurrence of infection. This patient refused to receive the second-stage revision. Only one patient underwent the second-stage revision. The remaining nine patients refused the second-stage revision. Three of the nine patients had slight pain,and six barely felt pain. The range of motion before and after the first-stage surgery were（ 62 ± 30） °（ 10°-100°） and（ 104 ± 9） °（ 90°-120°）（ t = 4. 659,P〈0. 01） respectively. The infection control rate was 90. 9%. Conclusion The re-implantation of original prostheses may be efficacy for the patients with periprosthetic infection after total knee arthroplasty.

关 键 词：关节成形术 置换 膝 感染 假体和植入物 

分 类 号：R687.4[医药卫生—骨科学]