人工关节假体周围感染的诊断及防治研究进展  

Research progress in diagnosis, prophylaxis, and treatment of periprosthetic joint infections

作　　者：韦健 童凯 周思齐 Wei Jian;Tong Kai;Zhou Siqi(Department of Sports Medicine and Joint Orthopaedics,Liuzhou People's Hospital,Liuzhou 545006,China;Department of Orthopaedics,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]柳州市人民医院运动医学与关节骨病科,柳州545006 [2]武汉大学人民医院骨外科,武汉430060

出　　处：《中华骨科杂志》2022年第21期1465-1472,共8页Chinese Journal of Orthopaedics

摘　　要：人工关节假体周围感染(periprosthetic joint infection,PJI)是关节置换术后最具破坏性的并发症之一,可导致患者关节疼痛、住院时间延长、反复多次手术、功能障碍甚至死亡。目前临床上缺乏特异性诊断PJI的有效方法,如何快速准确诊断及有效降低术后PJI发生率是国内外人工关节领域研究的热点与难点。革兰阳性菌是PJI最常见的致病菌,多重耐药病原菌、混合细菌感染及培养阴性的PJI患病率呈现增长趋势。致病微生物的流行病学数据可指导临床诊断及经验性用药,减少抗药菌株产生。最新专家共识也提出了新的诊断标准,细化了次要标准并赋予了详细的评分细则。新的生化标志物(如白细胞酯酶及α-防御素)、假体超声震荡联合基因检测、影像学检测(如同位素99mTc三相骨扫描)、二代基因测序等诊断方法有助于提高诊断的准确性。围手术期科学规范的管理方案及新的预防手段如术中创面内应用万古霉素粉、稀释碘伏冲洗等,有利于预防和减少PJI的发生。二期翻修仍是治疗慢性PJI的首选方法,而在明确病原菌的急性PJI或部分慢性PJI患者中应用一期翻修术联合关节内注射抗生素可有效治疗甚至根除PJI。Periprosthetic joint infection(PJI)is one of the destructive complications after artificial joint replacement,which leads to postoperative joint pain,prolonged hospital stays,repeated multiple operations,dysfunction and even mortality.However,there is no specific diagnosis method for PJI.Although some progress has been made in the research of pathogenic microorganisms,diagnostic criteria,prevention strategies and treatment regimens of PJI in recent years,the quick and accurate diagnose and reducing of postoperative PJI is still the hotspot and difficulty in the field of artificial joint replacement.Gram-positive bacteria are the most common pathogenic bacteria,the prevalence of multidrug resistant pathogens,mixed bacterial infections and culture negative bacteria remain increasing.The epidemiological data of pathogen can guide clinical diagnosis and empirical use of antibiotics,which can help reducing of resistant bacteria.The International Consensus Meeting(ICM)proposed new diagnostic criteria,refined secondary criteria and assigned detailed scoring rules.New biochemical markers(such as leucocyte esterase andα-defensin,etc.),sonication of prosthesis combined with gene detection,imaging detection(such as 3-phase bone scanning labeled with technetium-99m,etc.),and next-generation sequencing is helpful to improve the accuracy of PJI diagnosis.Scientific and standardized perioperative management programs and new preventive measures,such as intraoperative application of vancomycin powder and diluted iodophor irrigation,are benefit to prevent and reduce the occurrence of PJI.Two-stage revision is still the standard intervention for chronic PJI,while one-stage revision combined with intra-articular antibiotics injection can effectively eradicate PJI in patients with acute or some chronic PJI with clear pathogenic bacteria.

关 键 词：特异性诊断 评分细则 生化标志物 革兰阳性菌 骨扫描 抗药菌株 关节疼痛 人工关节 

分 类 号：R687.4[医药卫生—骨科学]