抗生素骨水泥占位器在膝关节假体周围感染二期翻修中的应用  

Application of antibiotic-loaded cement spacers in two-stage revision for periprosthetic joint infection after total knee arthroplasty

作　　者：于强[1] 田京[1] Yu Qiang;Tian Jing(Department of Orthopedics,Zhujiang Hospital of Southern Medical University,Guangzhou 510282,Guangdong Province,China)

机构地区：[1]南方医科大学珠江医院骨科中心,广东省广州市510282

出　　处：《中国组织工程研究》2018年第31期5048-5055,共8页Chinese Journal of Tissue Engineering Research

摘　　要：背景:抗生素骨水泥占位器在二期翻修手术治疗慢性膝关节假体周围感染中起到不可替代的作用,不仅能够维持关节间隙、防止肌肉挛缩,还可以增加关节腔内抗生素浓度,加快感染清除的进程。目前多种占位器可供选择,如何选择一个理想的占位器成为骨科医生共同的目标。目的:从假体周围感染概况入手,通过比较不同占位器的机械特性、临床效果等方面来具体阐述抗生素骨水泥占位器在膝关节假体周围感染后二期翻修中的应用,为临床选择和应用抗生素骨水泥占位器提供参考。方法:第一作者应用计算机检索1980年1月至2018年5月MEDLINE数据库、ScienceDirect全文数据库、中国期刊全文数据库、维普中文期刊网等有关抗生素骨水泥占位器在治疗假体周围感染中应用的文章,检索词"假体周围感染,抗生素骨水泥占位器,二期翻修,全膝置换术,感染",排除重复性研究。文章共检索到114篇相关文献,其中78篇文献符合纳入标准。结果与结论:(1)膝关节假体周围感染是全膝关节置换术后具有毁灭性打击的并发症之一,二期翻修目前被公认为是治疗膝关节假体周围感染的"金标准";(2)在二期翻修中所应用的抗生素骨水泥占位器可分为静态型占位器和活动型占位器,活动型占位器又可分为骨水泥-骨水泥界面型、骨水泥-聚乙烯界面型、金属-聚乙烯界面型;(3)每种占位器机械特性、材质、优势及不足均存在差异,临床效果也不尽相同;(4)目前针对如何选择占位器以达到最理想治疗效果这一问题并未有定论,但众多对比研究及循证医学分析结果为临床医生选择占位器提供了有效信息和参考。BACKGROUND:Antibiotic-loaded cement spacers have played an important role in two-stage revision for chronic periprosthetic joint infection.It can not only sustain articular space and prevent muscle contracture,but also increase the concentration of antibiotics in articular cavity and clear up the infection.There are many types of spacers,and how to choose an optimal spacer is the mutual goal for orthopedic surgeons.OBJECTIVE:To review the basic concept of periprosthetic joint infection as well as the two-stage revision,the types of knee spacers,the advantages and limitations of each kind of spacer,and to provide valuable information for surgeons to choose an optimal spacer.METHODS:The first author searched MEDLINE,Science Direct,CNKI and VIP databases for the articles addressing knee spacers used in two-stage revision after periprosthetic joint infection published between January 1980 and May 2018.The keywords were“periprosthetic joint infection,antibiotic-loaded cement spacer,two-stage revision,total knee arthroplasty,infection”in English and Chinese,respectively.Totally 114 articles were retrieved,and 78 articles were eligible for inclusion criteria.RESULTS AND CONCLUSION:(1)Periprosthetic joint infection of knee is a devastating complication after total knee arthroplasty.Two-stage revision is considered as the“gold standard”for prosthetic infection.(2)Spacers are used in two-stage revision process to prevent soft tissue contraction and to add an intra-articular concentration of antibiotics.Antibiotic-loaded cement spacers may be classified in two types:static spacers and articulating spacers.Several versions of articulating spacer interfaces are presently available:cement-on-cement,cementon-polyethylene,and metal-on-polyethylene.(3)Different spacers vary in mechanic characteristics and clinical outcomes.(4)At present,there is no clear consensus on the best selection of a spacer,but numerous comparative studies and meta-analysis have provided valuable information for surgeons to make the choice.

关 键 词：假体周围感染 抗生素骨水泥占位器 二期翻修 全膝置换术 感染 骨科植入物 关节成形术 置换 膝 假体植入 感染 抗菌药 

分 类 号：R318[医药卫生—生物医学工程]