保留假体清创抗生素硫酸钙治疗膝假体周围感染  

Debridement,antibiotics,and implant retention combined with antibiotic-loaded calcium sulfate implantation for periproshetic joint infection after total knee arthroplasty

作　　者：黄洪贞 朱世军 刘庆胜[1] 杨金三[1] 牛建兵[1] 牛福文[1] 李健[1] 聂志奎[1] HUANG Hong-zhen;ZHU Shi-jun;LIU Qing-sheng;YANG Jin-san;NIU Jianbing;NIU Fu-wen;LI Jian;NIE Zhi-kui(Department of Bone and Joint Surgery,The First People's Hospital of Jining City,Jining 272000,Shandong,China)

机构地区：[1]济宁市第一人民医院骨关节外科,山东济宁272000

出　　处：《中国矫形外科杂志》2025年第7期666-669,672,共5页Orthopedic Journal of China

基　　金：济宁市重点研发计划项目(编号:2024YXNS147)。

摘　　要：[目的]评价保留假体清创联合硫酸钙抗生素对膝关节置换(total knee arthroplasty,TKA)术后早期假体周围关节感染(periprosthetic joint infection,PJI)的疗效。[方法]2022年1月—2024年7月本科采用保留假体清创联合抗生素硫酸钙治疗收治的20例TKA术后早期PJI。评估患者的临床和影像资料。[结果]所有患者均顺利完成手术,术中、术后无严重并发症发生,患者出院时翻修手术切口均愈合良好。20例患者平均随访(15.4±7.7)个月,末次随访时18例治愈,治愈率90%。2例术后局部窦道形成,确诊为PJI复发,分别于保留假体清创术后22 d和40 d行假体取出骨水泥占位器置入,二期翻修后感染均控制。与术前相比,末次随访时VAS评分[(6.9±1.2),(2.3±1.7),P<0.001]显著降低,HSS评分[(48.6±7.9),(79.6±6.3),P<0.001],膝伸屈ROM[(86.0±15.4),(104.8±10.3),P<0.001]显著增加。辅助检查方面,20例患者中,细菌培养阳性11例,占55.0%,其中金葡菌4例。与术前相比,末次随访时ESR[(51.7±28.8)mm/h,(27.8±17.9)mm/h,P<0.01]、CRP[(69.8±64.6)mg/L,(21.4±17.5)mg/L,P<0.01]显著下降。末次随访时1例出现假体周边透亮带。[结论]保留假体清创抗生素硫酸钙可有效治疗膝关节置换术后早期感染,恢复关节功能。[Objective]To evaluate the clinical efficacy of debridement,antibiotics,and implant retention(DAIR)combined with antibiotic-loaded calcium sulfate implantation for periprosthetic joint infection(PJI)after total knee arthroplasty(TKA).[Methods]From January 2022 to July 2024,a total of 20 patients with early PJI after TKA were treated by debridement,antibiotics,and implant retention(DAIR)combined with antibiotic-loaded calcium sulfate implantation.The clinical and imaging data were evaluated.[Results]All patients had the operation performed successfully with no serious complications,and had the incisions of revision surgery healed well when the patients were discharged.At the latest follow-up lasted for(15.4±7.7)months in a mean,18 patients were cured,accounted for 90%.However,the remaining 2 patients with postoperative local sinus formation were diagnosed as PJI recurrence,underwent prostheses removed and bone cement spacer placed 22 days and 40 days after DAIR,respectively,had the infection controlled after the second stage of revision.Compared with those preoperatively,the VAS score significantly reduced[(6.9±1.2),(2.3±1.7),P 0.001],while HSS score[(48.6±7.9),(79.6±6.3),P<0.001]and knee flexion-extension ROM[(86.0±15.4),(104.8±10.3),P<0.001]was significantly increased at the final interview.In terms of auxiliary examination,11 of the 20 patients were positive for bacterial culture,accounting for 55.0%,including Staphylococcus aureus in 4 cases,as well as Staphylococcus epidermidis,Staphylococcus haemolyticus,Streptococcus agalactis,Klebsiella pneumoniae,Klebsiella acidogenes,candida parapsilosis And Brucella in 1 case for each.Compared with those preoperatively,the ESR[(51.7±28.8)mm/h,(27.8±17.9)mm/h,P 0.01]and CRP[(69.8±64.6)mg/L,(21.4±17.5)mg/L,P 0.01]dropped significantly at the last follow-up.As for imaging,only 1 patient had periprosthetic transparent band.[Conclusion]The antibiotic-loaded calcium sulfate does effectively treat the early infection after TKA and restore the joint function.

关 键 词：全膝关节置换术 假体周围感染 保留假体清创 载抗生素硫酸钙 

分 类 号：R687.4[医药卫生—骨科学]