成人终末期膝关节炎合并感染分期手术治疗的临床效果  

Clinical efficacy of staged surgical treatment for adult end-stage knee osteoarthritis complicated with infection

作　　者：张明昊 李祖希 杨宇豪 蒋青[1] 王渭君[1] ZHANG Minghao;LI Zuxi;YANG Yuhao;JIANG Qing;WANG Weijun(Department of Sports Medicine and Adult Reconstructive Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院运动医学与成人重建外科,南京210008

出　　处：《中华骨与关节外科杂志》2025年第4期331-337,共7页Chinese Journal of Bone and Joint Surgery

基　　金：国家重点研发计划(2021YFA1201400)。

摘　　要：目的:探讨分期手术治疗成人终末期膝关节炎合并感染的临床效果。方法:回顾性分析2018年1月至2021年12月南京大学医学院附属鼓楼医院采用分期手术治疗的8例终末期膝关节炎合并感染患者的临床资料。其中男5例,女3例,年龄54~73岁,平均(61.2±7.9)岁。患者术前或术中关节液细菌培养结果显示阳性,诊断为合并感染。采用一期行清创术、二期行人工关节置换术的方式进行分期手术治疗,并根据Gachter分级选择清创方式。比较一期清创术前与末次随访时患者美国特种外科医院膝关节评分(HSS)及美国膝关节协会评分(KSS),同时观察患者二期人工关节置换术后感染复发及其他并发症发生情况。结果:8例患者入院后实验室检查结果显示,红细胞沉降率、C反应蛋白水平均高于正常值;细菌培养结果为葡萄球菌感染7例,葡萄球菌合并链球菌感染1例。4例患者采用关节镜清创术;4例患者采用开放清创术,其中3例使用敏感抗生素骨水泥间隔器。控制感染后,8例患者均行二期全膝关节置换术。8例患者随访27~63个月,平均(42.9±11.0)个月。术后感染均无复发,假体植入后均未再次手术。末次随访时,患者HSS评分、KSS临床评分、KSS功能评分均较术前升高,差异均有统计学意义(P均<0.001)。结论:成人终末期膝关节炎合并感染的清创术方式根据患者Gachter分级确定,关节镜清创术和开放清创术均可获得良好的感染治疗效果;分期手术治疗成人终末期膝关节炎合并感染的效果良好。Objective:To explore the clinical efficacy of staged surgical treatment for end-stage knee osteoarthritis complicated with infection in adults.Methods:A retrospective analysis was conducted on 8 patients with end-stage knee osteoarthritis complicated with infection who underwent staged surgical treatment at Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,from January 2018 to December 2021.Among them,there were 5 males and 3 females,aged 54-73 years,with an average age of(61.2±7.9)years.Concurrent Infection was confirmed by positive bacterial culture from synovial fluid obtained preoperatively or intraoperatively.Staged treatment included first-stage debridement followed by second-stage total knee arthroplasty(TKA),with the debridement method selected according to the Gachter classification.Clinical outcomes were assessed by comparing the Hospital for Special Surgery(HSS)knee score and Knee Society Score(KSS)before the first-stage debridement and at the final follow-up.Postoperative infection recurrence and other complications after second-stage TKA were also recorded.Results:Laboratory examinations on admission revealed elevated erythrocyte sedimentation rate and C-reactive protein levels in all patients.Bacterial cultures identified Staphylococcus infection in 7 cases and mixed Staphylococcus-Streptococcus infection in 1 case.Four patients underwent arthroscopic debridement,and four underwent open debridement,among whom three received sensitive antibiotic-loaded bone cement spacers.After controlling the infection,all 8 patients underwent second-stage TKA.Follow-up ranged from 27 to 63 months(mean:[42.9±11.0]months),with no cases of infection recurrence or secondary revision surgery.At the final follow-up,significant improvements were observed in HSS,KSS clinical,and KSS functional scores compared to preoperative values(P<0.001).Conclusions:The choice of debridement method for end-stage knee osteoarthritis complicated with infection in adults should be guided by the Gäc

关 键 词：人工关节置换术 膝关节炎 清创 感染性关节炎 

分 类 号：R684.3[医药卫生—骨科学]