人工全膝關節置換術后深部感染的治療_《中國修復重建外科雜志》

作者：

孫振輝 , 王磊 , 孫云波 , 曹建剛 , 張宇 , 田孟強 , 劉軍

天津市人民醫院關節外科（天津，300121）;

關鍵詞：

人工全膝關節置換深部感染術后并發癥

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目的探討人工全膝關節置換（total knee arthroplasty，TKA）術后深部感染的處理方法及療效。方法2004年1月－2010年1月，收治TKA 術后深部感染患者32例（32膝）。男13例，女19例；年齡52～79歲，平均64.6歲。TKA手術距發生感染時間為3周～10年。膝關節功能采用膝關節學會評分系統（KSS）為（104.6 ± 9.1）分，疼痛視覺模擬評分（VAS）為（7.8 ± 1.4）分。急性感染3例行關節切開清創后持續沖洗；急性血源性播散感染3例于關節鏡下清創；慢性感染26例，其中行關節切開清創后持續沖洗9例，抗生素骨水泥隔體植入4例，二期翻修12例，抗生素保守治療1例。結果急性感染者治療均失敗，急性血源性播散感染者1例治療失敗，慢性感染者7例清創及1例保守治療失敗；均經對癥治療后治愈。32例患者均獲隨訪，隨訪時間2～8年，平均4.6年。末次隨訪時KSS評分為（158.4 ± 8.3）分，VAS評分為（4.1 ± 0.8）分，與術前比較差異有統計學意義（P lt; 0.05）。隨訪期間再感染3例，均為二期翻修患者。結論 TKA術后耐甲氧西林金黃色葡萄球菌急性感染切開清創成功率低；急性血源性播散感染可試行關節鏡下清創；慢性感染二期翻修膝關節功能恢復良好，但遠期存在再感染風險。

引用本文： 孫振輝,王磊,孫云波,曹建剛,張宇,田孟強,劉軍. 人工全膝關節置換術后深部感染的治療. 中國修復重建外科雜志, 2012, 26(8): 918-921. doi: 復制

1.	Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
2.	Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
3.	Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
4.	Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
5.	Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
6.	Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
7.	Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
8.	Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
9.	Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
10.	Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
11.	Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
12.	Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
13.	Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
14.	Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
15.	Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
16.	余世明, 張紫機, 盛璞義, 等. 兩種間隔器在膝關節置換術后假體感染的二期翻修術中應用的比較和分析. 中華關節外科雜志(電子版), 2010, 4(4): 482-487.
17.	Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
18.	Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
19.	Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.

1. Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
2. Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
3. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
4. Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
5. Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
6. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
7. Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
8. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
9. Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
10. Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
11. Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
12. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
13. Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
14. Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
15. Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
16. 余世明, 張紫機, 盛璞義, 等. 兩種間隔器在膝關節置換術后假體感染的二期翻修術中應用的比較和分析. 中華關節外科雜志(電子版), 2010, 4(4): 482-487.
17. Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
18. Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
19. Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.

《中國修復重建外科雜志》

人工全膝關節置換術后深部感染的治療

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《中國修復重建外科雜志》

人工全膝關節置換術后深部感染的治療

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

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Content

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