應用抗生素骨水泥間隔體二期翻修治療人工全膝關節置換術后遲發感染_《中國修復重建外科雜志》

作者：

蔡碰德 , 胡懿郃 , 謝杰 , 汪龍

中南大學湘雅醫院骨科（長沙，410008）;

關鍵詞：

人工全膝關節置換術遲發感染二期翻修術抗生素骨水泥間隔體

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目的探討應用抗生素骨水泥間隔體二期翻修治療人工全膝關節置換術后遲發感染的臨床療效。方法2007年1月－2009年12月，收治23例（23膝）人工全膝關節置換術后遲發感染患者。男15例，女8例；年齡43～75歲，平均65.2歲。置換術后至出現感染時間為13～52個月，平均17.3個月；發生感染至入院翻修時間為15 d～7個月，平均2.1個月。一期清創、取出假體，植入含慶大霉素抗生素骨水泥間隔體；8～10周感染控制后二期植入假體。分別采用美國特種外科醫院（HSS）評分及膝關節學會評分系統（KSS）評價翻修前后患膝功能，并統計總體感染控制率。結果術后患者切口均Ⅰ期愈合。2例二期翻修術后發生再感染，余21例感染控制，總體感染控制率91.3%。患者均獲隨訪，隨訪時間2～5年，平均3.6年。HSS評分由術前（60.6 ± 9.8）分提高至末次隨訪時（82.3 ± 7.4）分，KSS評分由術前（110.7 ± 9.6）分提高至末次隨訪時（134.0 ± 10.5）分，手術前后比較差異均有統計學意義（P lt; 0.01）。X線片復查示假體位置良好，無松動、斷裂、假體周圍透亮影等異常表現。結論應用抗生素骨水泥間隔體二期翻修能有效控制人工全膝關節置換術后遲發感染，并能較好恢復患膝功能。

引用本文： 蔡碰德,胡懿郃,謝杰,汪龍. 應用抗生素骨水泥間隔體二期翻修治療人工全膝關節置換術后遲發感染. 中國修復重建外科雜志, 2012, 26(10): 1169-1173. doi: 復制

1.	Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
2.	Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
3.	Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
4.	Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
5.	Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
6.	Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
7.	Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
8.	Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
9.	Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
10.	史占軍, 肖軍, 李朋. 人工關節置換術后假體周圍感染的診斷. 中華骨科雜志, 2010, 30(6): 626-629.
11.	Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
12.	Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
13.	曹力, 阿斯哈爾江, 張曉崗, 等. 一期翻修術治療全膝關節置換術后感染. 中華骨科雜志, 2011, 31(2): 131-136.
14.	Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
15.	Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
16.	Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
17.	Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
18.	Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
19.	蔣垚, 沈灝, 張先龍, 等. 帶抗生素可活動關節骨水泥間隔在全膝關節置換術后感染中的應用. 中華骨科雜志, 2006, 26(12): 827-830.
20.	Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
21.	Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
22.	MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
23.	Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
24.	Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
25.	Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
26.	Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
27.	Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
28.	Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
29.	Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
30.	Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
31.	Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
32.	Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.

1. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
2. Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
3. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
4. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
5. Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
6. Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
7. Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
8. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
9. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
10. 史占軍, 肖軍, 李朋. 人工關節置換術后假體周圍感染的診斷. 中華骨科雜志, 2010, 30(6): 626-629.
11. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
12. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
13. 曹力, 阿斯哈爾江, 張曉崗, 等. 一期翻修術治療全膝關節置換術后感染. 中華骨科雜志, 2011, 31(2): 131-136.
14. Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
15. Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
16. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
17. Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
18. Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
19. 蔣垚, 沈灝, 張先龍, 等. 帶抗生素可活動關節骨水泥間隔在全膝關節置換術后感染中的應用. 中華骨科雜志, 2006, 26(12): 827-830.
20. Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
21. Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
22. MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
23. Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
24. Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
25. Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
26. Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
27. Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
28. Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
29. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
30. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
31. Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
32. Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.

《中國修復重建外科雜志》

應用抗生素骨水泥間隔體二期翻修治療人工全膝關節置換術后遲發感染

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《中國修復重建外科雜志》

應用抗生素骨水泥間隔體二期翻修治療人工全膝關節置換術后遲發感染

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