急性膝假体周围感染保留假体治疗8年经验  

Eight-year experience in debridement,antibiotics and implant retention for acute periprosthetic infection of the knee

作　　者：程永刚 乔永杰 李峰[1,3] 刘浩[1] 宋晓阳[1] 周胜虎[1] CHENG Yong-gang;QIAO Yong-jie;LI Feng;LIU Hao;SONG Xiao-yang;ZHOU Sheng-hu(The 940th Hospital,Joint Logistic Support Force of CP LA,Lanzhou 730050,China;Northwest University for Nationalities,Lanzhou 730030,China;The 943^(st)Hospital,Joint Logistic Support Force of CPLA,Wuwei 733000,China)

机构地区：[1]中国人民解放军联勤保障部队第九四○医院,甘肃兰州730050 [2]西北民族大学,甘肃兰州730030 [3]中国人民解放军联勤保障部队第九四三医院,甘肃武威733000

出　　处：《中国矫形外科杂志》2022年第7期603-607,共5页Orthopedic Journal of China

摘　　要：[目的]探讨清创保留假体(debridement,antibiotics and implant retention,DAIR)联合滴注引流治疗急性膝关节假体周围感染(periprosthetic joint infection,PJI)的临床疗效.[方法]回顾性分析2012年1月—2020年6月本院收治的21例(21膝)急性PJI患者的临床资料.所有患者均采用DAIR联合滴注引流治疗,比较手术前后VAS评分、膝关节HSS评分、膝伸屈活动度ROM及实验室检查结果变化情况,评估感染治愈率.[结果]所有患者均顺利完成手术,术中无血管、神经损伤等严重并发症.21例患者随访(3.62±2.50)年.其中,15例感染治愈,占71.43%;6例感染复发,占28.57%,后经二期翻修术恢复良好.术后随时间推移,膝关节HSS评分、膝伸屈ROM较术前显著增加(P<0.05),而VAS评分较术前显著降低(P<0.05).细菌学方面,21例患者细菌培养阳性结果14例,阴性结果7例.阳性病例中金黄色葡萄球菌8例,包括MRSA 5例,表皮葡萄球菌3例,铜绿假孢杆菌1例;革兰阴性杆菌2例.检验方面,术后ESR、CRP、IL-6较术前均显著降低(P<0.05).影像显示,末次随访X线片示假体位置良好,无断裂、松动,未见明显透光影.[结论]DAIR联合滴注引流在治疗急性PJI中能够有效控制感染且保留良好的关节功能.[Objective]To explore the clinical outcomes of debridement,antibiotics and implant retention(DAIR)combined with irrigation drainage for periprosthetic joint infection(PJI).[Methods]A retrospective study was done on 21 patients(21 knees)who were admitted into our hospital for acute PJI from January 2012 to June 2020.All patients were treated with DAIR combined with irrigation and drain-age.The VAS and HSS scores,as well as knee extensor-flexion range of motion(ROM)and laborator\r test results were compared among different time points,additionally the successful rate of infection control was evaluated.[Results]All patients were successfully operated on without serious complications such as vascular and nerve injury.The 21 patients were followed up for(3.62±2.50)years.Among them.15 cases got successful infection control,accounted for 71.43%,whereas the remaining 6 patients had infection recurred,accounted for 28.57%,which controlled well after the two-stage revision.The HSS score and ROM increased significantly(P<0.05),whereas the VAS score decreased significantly over time postoperatively(P<0.05).In terms of bacteriology.14 patients got positive results,while 7 were of negative among the 21 patients.The positive results involved 8 cases of staphylococcus aureus,including 5 cases of MRSA;3 cases of Staphylococcus epidermidis;1 case of pseudomonas aeruginosa and 2 cases of gram-negative bacilli.In terms of blood test,ESR,CRP and IL-6 were significantly decreased after operation compared with those preoperatively(P<0.05).The regular radiographic checks revealed that the prosthetic components remained in proper positions without fracture,loosening,and no obvious lightening shadow was seen.[Conclusion]The DAIR combined with irrigation drainage do effectively control infection and preserve good joint function for acute PJI.

关 键 词：全膝关节置换术 假体周围感染 清创术 假体保留 

分 类 号：R687[医药卫生—骨科学]