摘要
目的探讨关节型全抗生素骨水泥间隔物治疗全膝关节置换术（TKA）后假体感染的中长期转归。方法在上海交通大学附属第六人民医院关节外科的假体关节感染资料库中选取从2004年6月至2010年6月,采用关节型抗生素骨水泥间隔物治疗全膝关节假体术后感染患者28例。入选患者男性11例,女性17例;年龄56-87岁,平均（73±7）岁。一期手术彻底清创＋取出假体＋间隔物植入。术中采用骨水泥制模,植入带抗生素骨水泥关节型间隔物。术后可早期部分负重,关节屈伸活动,选用敏感抗生素治疗6周,感染控制后再植入高限制性假体。根据Delphi标准判别感染是否控制。结果对本组患者随访8（4-12）年。28例中有20例在植入间隔物后接受假体再植入术,随访感染控制率为85%（17/20）。另有8例植入关节型间隔物后未再植入假体,其中2例最终行关节融合术,3例行膝上截肢,另3例感染控制未再植入假体。结合再植入假体和保留间隔物的总体感染控制率（除外截肢）为78.6%（22/28）。间隔期间隔物并发症包括1例间隔物脱位、2例间隔物断裂和1例间隔物从骨端脱出。结论采用关节型全抗生素骨水泥间隔物结合二期翻修治疗TKA后假体周围感染可以取得较高的成功率;但有相当一部分病例在植入间隔物后未再植入假体,在报道总体治疗成功率的时需要考虑这部分病例,并对其最终转归给予关注。
Objective To observe the medium to long term outcomes of the treatment of the prosthetic infection following total knee arthroplasty（ TKA） using cement-on-cement antibiotic-loaded articulating spacers. Methods From Jun. 2004 to Jun. 2010,28 cases with periprosthetic knee infection had been treated with antibiotic-loaded articulating spacers. These cases included 11 men and 17 women.The average age was（ 73 ± 7） years（ range,56-87 years）. The initial procedure consisted of thorough debridement,removal of hardware, fabrication of cement molds and implantation of antibiotic-loaded articulating spacer. The postoperative course consisted of graduated knee motion and partial weight-bearing activity. Each patient received a 6-week course of organism-sensitive antibiotic therapy. High restricted prosthesis was implanted after infection was controlled. Successful control of infection was judged according to the criteria based on the Delphi international multidisciplinary consensus. Results The average length of follow-up was eight（ 4-12） years. Twenty of the 28 cases received re-implantation,with an infection control rate of 85%（ 17 /20） at the latest follow-up. The other eight cases did not receive joint prothesis after the implantation of the articulating spacers. Among the eight cases,two cases received arthrodesis,three cases accepted the above-knee amputation, the other three cases did not undergo prothesis implantation after successful infection control. The overall success rate was 78. 6% when the patients who underwent re-implantation and the patients who retained spacers were considered together. There were two cases of spacer fracture,one case of dislocation and one case of spacer disassociation from the bone stock during the interim period. Conclusions Infection following TKA could be successfully treated with this two-stage revision protocol using antibiotic-loaded cement-on-cement articulating spacers which shows a high success rate. As a certain portion of patients did not receive reimpla
出处
《中华关节外科杂志（电子版）》
CAS
2016年第4期11-16,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
国家自然科学基金(81472108)
关键词
关节成形术
置换
膝
假体相关感染
再手术
Arthroplasty
replacement
knee
Prosthesis-related infections
Reoperation
