二期翻修术治疗膝关节真菌性假体周围感染的疗效分析  

Efficacy analysis of two-stage revision surgery in the treatment of fungal periprosthetic knee joint infection

作　　者：吴凌霄 于洋[1] 谭俊 江旭 许建中[1] WU Ling-xiao;YU Yang;TAN Jun;JIANG Xu;XU Jian-zhong(Department of Orthopaedics,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,450052,China)

机构地区：[1]郑州大学第一附属医院,河南450052

出　　处：《中国骨与关节杂志》2023年第2期103-109,共7页Chinese Journal of Bone and Joint

摘　　要：目的对采用二期翻修手术治疗膝关节真菌性假体周围感染(periprosthetic joint infection,PJI)进行疗效分析;描述膝关节真菌性PJI患者临床特征,结合已报道文献,提高对膝关节真菌性PJI的认识。方法回顾性分析2015年5月至2020年8月我院骨科收治的14例行二期翻修手术治疗的膝关节真菌性PJI患者,男5例,女9例。年龄60~86岁,平均70.8岁,均接受二期翻修手术治疗且于术中行组织细菌培养及药敏试验。所有患者均依据药敏实验结果全身应用抗生素治疗。定期随访感染控制情况、关节活动度(range of motion,ROM)、美国膝关节协会评分(Knee Society Score,KSS)、美国特种外科医院(the Hospital for Special Surgery,HSS)膝关节评分等。分析其临床特征、病原学及预后。结果14例随访12~74个月,平均35.6个月,所有患者均接受二期翻修手术治疗,感染控制率为85.7%(12/14)。培养结果为近平滑念珠菌7例(50.0%),白色念珠菌3例(21.4%),产脘念珠菌1例(7.1%),克柔念珠菌1例(7.1%),产脘假丝酵母菌1例(7.1%),角膜假丝酵母菌1例(7.1%)。14例真菌对氟康唑、两性霉素B、伏立康唑敏感率为100%;1例产脘假丝酵母菌与1例角膜假丝酵母菌对伊曲康唑耐药。ROM由旷置术前的(68.4±8.1)°提高至末次随访时(99.6±9.5)°;KSS评分由旷置术前的(37.2±5.0)分提高至末次随访时(82.2±10.3)分;HSS膝关节评分由旷置术前的(57.6±9.4)分提高至末次随访时(81.1±7.5)分。末次随访时所有患者均无感染症状。结论全膝关节置换术后真菌性PJI是一症状不典型、发病隐匿、确诊困难、治疗期漫长的疾病,但二期翻修手术可以作为膝关节真菌性PJI的有效治疗手段,其根治率高,并发症少,患肢功能改善佳,可以显著提高患者的生活质量。Objective To analyze the efficacy of two-stage revision surgery in the treatment of fungal periprosthetic knee joint infection;to describe the clinical characteristics of patients with fungal PJI after TKA,and to improve the understanding of the fungal PJI of the knee joint based on our study and the reported literature.Methods A retrospective study was conducted based on 14 patients who had undergone two-stage revision for fungal periprosthetic knee joint infection from May 2015 to August 2020 at Department of Orthopedics,The First Affiliated Hospital of Zhengzhou University.There were 5 males and 9 females,with an average age of 70.8 years(range:60-86 years).All patients were treated with two-stage revision surgery.Tissue culture and drug susceptibility testing during surgery was applied.In addition,all patients were treated with systemic antibiotics according to the results of drug susceptibility test.Infection control,range of motion(ROM),American Knee Society Score(KSS)and the Hospital for Special Surgery(HSS)knee score were recorded to analyze the clinical features,manifestations,etiology and prognosis of patients.Results All patients were followed up for an average of 35.6 months(range:12-74 months).Tow-staged revision surgery was performed in all patients,and the infection control rate was 85.7%(12/14).Intraoperative tissue biopsies culture results:candida parapsilosis in 7 cases(50.0%),candida albicans in 3 cases(21.4%),candida cavitatum in 1 case(7.1%)and candida cornea in 1 case(7.1%).The sensitivity rate of 14 fungi to fluconazole,amphotericin B and voriconazole was 100%;one case of candida cavitatum and one case of candida cornea were resistant to itraconazole.At the last follow-up,ROM increased from preoperative(68.4±8.1)°to(99.6±9.5)°,the KSS and HSS knee score increased from preoperative(37.2±5.0)and(57.6±9.4)to(82.2±10.3)and(81.1±7.5),respectively.None of the patients was clinically symptomatic of infection at the last follow-up.Conclusions Fungal periprosthetic infection after TKA is dif

关 键 词：假体相关感染 真菌 关节成形术 置换 膝 再手术 膝关节 

分 类 号：R684[医药卫生—骨科学]