负压封闭引流结合敏感抗生素治疗假体周围急性感染  

Treatment of acute infection around prosthesis with vacuum sealing drainage and sensitive antibiotics

作　　者：史文骥[1] 毛宾尧[1] 施靖宇 SHI Wen-ji;MAO Bin-yao;SHI Jing-yu(Department of Orthopaedics,the First Hospital of Ningbo,Ningbo 315010,Zhejiang,China;不详)

机构地区：[1]宁波市第一医院浙江大学宁波医院骨科,浙江宁波315010 [2]宁波大学医学院,浙江宁波315000

出　　处：《中国骨伤》2020年第6期566-571,共6页China Journal of Orthopaedics and Traumatology

摘　　要：目的:探讨负压封闭引流(vacuum sealing drainage,VSD)结合敏感抗生素治疗假体周围急性感染的疗效。方法:回顾性分析2012年3月至2018年12月采用保留假体的清创、VSD、敏感抗生素治疗11例假体周围急性感染,男7例,女4例;年龄58~88岁,平均72.5岁。髋关节假体周围感染8例,3例出现窦道,膝关节假体周围感染3例。结果:微生物培养阴性2例,阳性9例,金黄色葡萄球菌7例,其中2例耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA),表皮葡萄球菌2例。术后随访8~52个月,平均28个月,1例髋关节假体周围感染清创失败,清创距关节置换时间84 d,行II期人工关节翻修术。10例清创成功。末次随访时,髋关节假体周围感染清创成功患者Harris评分84.1(74~93)分;膝关节假体周围感染者膝关节协会评分(Knee Society score,KSS)84,84,89分。结论:膝关节置换术后1个月内,髋关节置换术后6周内假体周围急性感染,及服用抗凝药物引起假体周围出血伴急性感染,采用保留假体的清创,VSD及敏感抗生素治疗,可获得较满意的效果。Objective:To investigate the therapeutic effects of vacuum sealing drainage(VSD)combined with antibiotics in treating acute periprosthetic joint infection(PJI).Methods:From March 2012 to December 2018,there were 11 patients with acute PJI underwent debridement,VSD,antibiotics and retention of implant,including 7 males and 4 females,with an average age of 72.5 years old(ranged,58 to 88 years old).There were 8 hips and 3 knees.Three patients had sinus tract.Results:There were 2 patients with negative culture result and 9 patients with positive culture result,including 5 cases of methicillin-sensitive staphylococcus aureus,2 cases of methicillin-resistant staphylococcus aureus(MRSA),2 cases of staphylococcus epidermidis.The mean follow-up duration was 28 months(ranged from 8 to 52 months).One case of infection around hip prosthesis failed to be debrided.The time of debridement and replacement of the calcar joint was 84 days.Debridement was successful in 10 cases.At the latest follow-up,Harris score of patients with successful debridement of hip periprosthetic infection ranged from 74 to 93,with an average score of 84.1;Knee Society scores of patients with periprosthetic infection were84,84,89.Conclusion:For acute infection around the prosthesis within 1 month after knee replacement and 6 weeks after hip replacement,and for bleeding around the prosthesis with acute infection caused by anticoagulant drugs,satisfactory results can be obtained by debridement,VSD and sensitive antibiotics.

关 键 词：假体相关感染 引流术 清创术 

分 类 号：R687.4[医药卫生—骨科学]