二期翻修术治疗微生物培养阳性膝关节置换术后假体周围感染的疗效分析  

Efficacy of two-stage revision on culture-positive periprosthetic joint infection after total knee arthroplasty

作　　者：王华溢 杨重飞 朱锦宇 曹晓瑞 陈永峰 孙强 张大伟 朱庆生 WANG Huayi;YANG Chongfei;ZHU Jinyu;CAO Xiaorui;CHEN Yongfeng;SUN Qiang;ZHANG Dawei;ZHU Qingsheng(Department of Orthopaedics,The First Affiliated Hospital of Air Force Military Medical University,Xi'an 710032;Department of Orthopaedics,Southern University of Science and Technology Hospital,Shenzhen 518000,Guangdong,China)

机构地区：[1]空军军医大学第一附属医院骨科,西安710032 [2]南方科技大学医院骨科医学部,广东深圳518000

出　　处：《中华骨与关节外科杂志》2021年第12期995-1000,共6页Chinese Journal of Bone and Joint Surgery

摘　　要：目的:通过回顾性分析二期翻修手术治疗微生物培养阳性膝关节假体周围感染治疗过程,评估感染控制效果及临床功能结果。方法:收集2010年1月至2017年12月经二期翻修治疗的人工全膝关节置换术后假体周围感染微生物培养阳性病例共56例(56膝),对不同微生物感染的治疗过程、围手术期抗生素应用的感染控制效果进行归纳总结,并对感染控制效果进行评估。结果:采用二期翻修术治疗的56例患者中感染治愈共49例(87.5%),其中44例(78.6%)保留关节功能,另5例经关节融合治愈感染;感染控制失败7例,失败率为12.5%。所有感染微生物中耐甲氧西林葡萄球菌占比(28.6%)最高,共16例。结论:微生物培养阳性结果能够为医师正确地选择和使用抗生素提供微生物学证据,结合二期翻修术治疗膝关节假体周围感染,能够达到比较满意的感染治疗效果。Objective: To analyze clinical treatment process of two-stage revision on periprosthetic joint infection after total knee arthroplasty and to evaluate the healing effect on infections and clinical functional outcomes. Methods: A total of 56 patients(56 knee) with positive culture microorganism after periprosthetic knee infection who undertook two-stage revision from January 2010 to December 2017 were enrolled in the study. The treatment process of different microbial infections and the infection control effect of perioperative antibiotic application were summarized, and the infection control effect was evaluated.Results: forty-nine patients(87.5%) with periprosthetic joint infections after total knee arthroplasty were cured eventually after the two-stage revision including 44 patients(78.6%) preserved their function of the joint and 5 patients eradicated infection by arthrodesis. Infection control was failed in 7 patients, and the failure rate was 12.5%. Sixteen patients were infected by Methicillin-resistant Staphylococcus which was the most common microorganism(28.6%). Conclusions: The positive microorganism culture result can guide orthopedic surgeons to choose and use antibiotics reasonably, improve therapeutic outcome and preserve joint function in the process of second-stage revision treatment of periprosthetic knee infections.

关 键 词：假体周围感染 全膝关节置换术 培养阳性 二期翻修 抗生素骨水泥 金黄色葡萄球菌 肠球菌 感染治疗 

分 类 号：R687.4[医药卫生—骨科学]