摘要
目的探讨感染性膝关节假体二期翻修术中应用3D打印技术联合细菌培养的临床价值。方法假体周围感染(periprosthetic joint infection, PJI)患者12例,取出感染膝关节假体及关节内多间室组织进行细菌培养,根据培养及药物敏感实验结果应用敏感抗生素,感染控制后行二期翻修术。术前均采用3D打印技术打印膝关节模型,根据骨缺损AROI分型指导假体选择,并制定二期翻修术方案、进行预手术。观察二期翻修术中骨缺损实际分型及假体应用;观察术后3个月并发症发生情况及术前、末次随访时患膝关节活动度(range of motion, ROM)、美国特种外科医院膝关节评分(Hospital for Special Surgery Knee Score, HSS)、视觉模拟评分(visual analogue scale, VAS),评估手术效果。结果 12例经敏感抗生素治疗28~84(44±9)d,感染均控制;12例均顺利完成二期翻修术,术前3D打印模型对骨缺损分型与术中实际分型情况一致,假体选择合适;术后3个月均无假体松动、移位及感染发生;随访(15±7)个月,末次随访时手术效果优1例,良10例,中等1例;末次随访时VAS评分[(1.92±1.04)分]低于术前[(7.00±0.91)分],HSS评分[(76.33±5.02)分]高于术前[(43.08±4.78)分],ROM[(89.17±8.86)°]较术前[(50.83±16.56)°]增大(P<0.05)。结论 3D打印技术可准确评估行感染性膝关节假体翻修术患者的骨缺损,指导假体选择,联合细菌培养治疗PJI效果确切,可减轻疼痛,改善膝关节功能。
Objective To explore the clinical outcome of 3D printing combined with bacterial culture technology in infectious knee prosthesis revision. Methods The infected knee prosthesis and the intra-articular multi-compartment tissues were taken out for bacterial culture in 12 patients with periprosthetic joint infection. The sensitive antibiotics were applied according to the bacterial culture result. After the infection was controlled, 3D models were printed and constructed. The prosthesis was selected according to AROI classification of bone defects before the second revision plan was formulated and pre-operation was performed. The classification of bone defects in revision and the prosthesis chosen were recorded. The complications 3 months after operation, and the range of motion (ROM) of the knee joint, the Hospital for Special Surgery Knee Score (HSS) and visual analogue scale (VAS) score before and at the final survey were recorded. The operation result was evaluated. Results The infection was controlled after antibiotic therapy for 28 to 84 (44±9) d, and the operation was completed smoothly in all patients. The classification of bone defects by preoperative planning 3D model was consistent with the actual classification during operation. The actual prosthesis selection was proper. No prosthesis loosening, translocation or infection occurred in 3 months after operation. The results of follow-up for (15±7) months showed excellent in 1 case, good in 10 cases and medium effect in 1. The VAS score (1. 92± 1. 04) was significantly lower, the HSS score (76. 33 ±5. 02 ) was significantly higher and ROM (( 89. 17 ±8. 86)°) was significantly larger at the final survey than that before operation (7. 00±0. 91, 43. 08±4. 78,(50. 83± 16. 56)°)(P<0. 05). Conclusion 3D printing can accurately assess the bone defect and guide the selection of prosthesis. 3D printing combined with bacterial culture technology is effective for periprosthetic joint infection, relieve pain and improve knee joint function.
作者
段亮
时亮
徐洪海
祁洁
弓立群
范亚一
DUAN Liang;SHI Liang;XU Honghai;QI Jie;GONG Liqun;FAN Yayi(Department of Orthopedics , Shaanxi People's Hospital, Xi'an 710068,China)
出处
《中华实用诊断与治疗杂志》
2019年第7期665-667,共3页
Journal of Chinese Practical Diagnosis and Therapy
基金
陕西省自然科学基金(2014JQ4125)
陕西省科技统筹创新工程计划项目(2015KTCL-03-02)
关键词
假体周围感染
二期翻修术
3D打印
细菌培养
膝关节
periprosthetic joint infection
revision
3D printing
bacterial culture
knee joint
