活动型占位器治疗膝关节慢性假体周围感染的疗效分析  

Clinical outcomes of articulating spacers in treatment of chronic knee periprosthetic joint infection

作　　者：吴百健 黄子达[1] 王度 方心俞[1] 张超凡[1] 李文波[1] 张文明[1] Wu Baijian;Huang Zida;Wang Du;Fang Xinyu;Zhang Chaofan;Li Wenbo;Zhang Wenming(Department of Articular Surgery,The First Affiliated Hospital to Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院关节外科,福州350005

出　　处：《中华创伤骨科杂志》2021年第5期414-421,共8页Chinese Journal of Orthopaedic Trauma

基　　金：国家自然科学基金面上项目(82072458);福建省科技厅科技创新联合资金项目(2019Y9136);福建省医学创新课题(2020CXA038)。

摘　　要：目的探讨活动型膝关节占位器治疗膝关节慢性假体周围感染(PJI)的临床疗效。方法本研究纳入2014年1月至2020年1月间因膝关节慢性PJI于福建医科大学附属第一医院关节外科行二期翻修治疗的38例患者进行回顾性分析。男8例,女30例;年龄37~84岁,平均66.2岁。所有患者均为单侧发病,左侧19例,右侧19例。根据第一阶段清创手术使用活动型占位器不同分为3组:金属-聚乙烯组(10例),金属-骨水泥组(15例)和骨水泥组(13例)。待感染控制后行第二阶段翻修手术时对取出的占位器进行超声裂解处理及微生物培养。术后定期随访感染控制、关节活动度(ROM)、膝关节协会(KSS)临床评分和功能评分及并发症发生情况。结果38例患者术后获13~75个月(平均30.8个月)随访。所有患者均接受了第一阶段占位器植入手术,37例感染得到控制,感染控制率为97.4%(37/38)。金属-聚乙烯组、金属-骨水泥组和骨水泥组第一阶段术后ROM分别为95.0°±11.3°、92.9°±8.3°、75.5°±11.9°,KSS临床评分分别为(79.4±6.1)、(77.3±4.0)、(73.0±7.2)分,KSS功能评分分别为(67.5±11.8)、(69.0±10.4)、(60.8±11.0)分。以上项目各组组内术后均较术前显著改善,差异有统计学意义(P<0.05)。金属-聚乙烯组和金属-骨水泥组患者的ROM均显著优于骨水泥组患者,差异有统计学意义(P<0.05)。共32例患者完成第二阶段翻修手术,金属-聚乙烯组(7例)、金属-骨水泥组(12例)、骨水泥组(13例)第二阶段术后ROM分别为104.6°±9.8°、98.5°±8.7°、86.1°±8.9°,KSS临床评分分别为(85.3±4.6)、(82.7±4.3)、(78.0±4.8)分,KSS功能评分分别为(78.6±6.9)、(77.3±8.2)、(69.5±8.3)分,以上项目均较第一阶段术后显著改善,差异有统计学意义(P<0.05)。术后占位器的超声裂解液培养结果均为阴性。结论活动型占位器能够有效控制膝关节PJI,并改善翻修间隔期及翻修后的膝关节功能,同时"金属"型�Objective To explore the clinical outcomes of articulating spacers in the treatment of chronic knee periprosthetic joint infection(PJI).Methods A retrospective study was conducted of the 38 patients who had undergone stage-two revision for chronic knee PJI from January 2014 to January 2020 at Department of Articular Surgery,The First Affiliated Hospital to Fujian Medical University.They were 8 men and 30 women,aged from 37 to 84 years(average,66.2 years).The PJI was unilateral in all,affecting 19 left sides and 19 right sides.According to the kind of spacers used in the stage-one revision,they were divided into 3 groups:metal-polyethylene one(10 cases),metal-cement one(15 cases)and cement one(13 cases).In the stage-two revision following infection control,the spacers were removed for sonication and microbial culture.Infection control,range of motion(ROM),Knee Society Score(KSS),and complications were followed up.Results The 38 patients were followed up for an average of 30.8 months(from 13 to 75 months).All patients underwent spacer implantation at stage-one revision and infection was controlled in 37 of them(97.4%,37/38).After stage-one revision,metal-polyethylene,metal-cement and cement groups achieved 95.0°±11.3°,92.9°±8.3°and 75.5°±11.9°in ROM,79.4±6.1,77.3±4.0 and 73.0±7.2 in clinical KSS and 67.5±11.8,69.0±10.4 and 60.8±11.0 in functional KSS,showing significant improvements in the above indexes between preoperation and postoperation(P<0.05).The ROMs for the metal-polyethylene and metal-cement groups were significantly better than for the cement group(P<0.05).A total of 32 patients completed stage-two revision,with 7 in the metal-polyethylene group,12 in the metal-cement group and 13 in the cement group.Respectively,ROMs after stage-two revision were 104.6°±9.8°,98.5°±8.7°and 86.1°±8.9°,clinical KSSs 85.3±4.6,82.7±4.3 and 78.0±4.8 and functional KSSs 78.6±6.9,77.3±8.2 and 69.5±8.3 for the metal-polyethylene,metal-cement and cement groups,showing significant improvements after s

关 键 词：关节成形术 置换 假体相关感染 膝关节 人工 占位器 二期翻修 

分 类 号：R687.4[医药卫生—骨科学]