Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of c...Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.展开更多
背景:虽然关节置换围术期处置已经形成了一套标准化的流程,但是关节置换后假体周围感染仍是一个尚未彻底解决的难题,治疗方案依然没有达成共识。随着患者的不断增多,迫切需要具有指南意义的规范化治疗方案。目的:综述近年国外关节置换...背景:虽然关节置换围术期处置已经形成了一套标准化的流程,但是关节置换后假体周围感染仍是一个尚未彻底解决的难题,治疗方案依然没有达成共识。随着患者的不断增多,迫切需要具有指南意义的规范化治疗方案。目的:综述近年国外关节置换后假体周围感染的研究进展。方法:第一作者应用计算机检索1998至2019年PubMed数据库、Springerlink数据库的相关文章,英文检索词"Joint replacement,Periprosthetic joint infection,Progress in diagnosis and treatment";共检索到400余篇相关文献,50篇文献符合纳入标准。结果与结论:(1)随着新型血清标志物α-防御素和白细胞酯酶及D-二聚体、新型核医学检验方法及利用代谢组学和蛋白质组学等新方法的提出,可以凭借早期感染的生物标志物发现和诊断假体周围感染;(2)此外可以利用新的技术来破坏生物膜、微生物繁殖过程以及定量分子方法来提高病原体鉴定的准确性;(3)随着这些假体周围感染治疗进展的出现,快速、准确、经济的方法可能使明确诊断及培养出致病菌成为一件简单的事,那么很多病例都可以选择一期翻修;如若软组织条件不好或者不满足一期翻修的条件,则可进入二期翻修;(4)明确致病微生物,可以使用敏感的药物进行治疗,为二期翻修做好充足的准备,这对于假体周围感染治疗具有划时代的意义。展开更多
文摘Periprosthetic joint infections(PJI) of the hip and the knee are grossly classified as early post-operative, acute hematogenous and late chronic infections. Whereas two-stage exchange arthroplasty is the standard of care in North America for treating chronic infections, irrigation and debridement(I and D) with retention of implants has been used in an attempt to treat the other two types of PJIs. The rationale of this approach is that a PJI may be eradicated without the need of explanting the prostheses, as long as it has not transitioned into a chronic state. With the present paper, we review current evidence regarding the role of I and D with implant retention for treating PJIs of the hip and the knee. While a very wide range of success rates is reported in different studies, a short period of time between initiation of symptoms and intervention seems to play a prominent role with regards to a successful outcome. Moreover, pathogens of higher virulence and resistance to antibiotics are associated with a poorer result. Specific comorbidities have been also correlated with a less favorable outcome. Finally, one should proceed with serial I and Ds only under the condition that a predefined,aggressive protocol is applied. In conclusion,when treating a PJI of the hip or the knee, all the above factors should be considered in order to decide whether the patient is likely to benefit from this approach.
文摘背景:虽然关节置换围术期处置已经形成了一套标准化的流程,但是关节置换后假体周围感染仍是一个尚未彻底解决的难题,治疗方案依然没有达成共识。随着患者的不断增多,迫切需要具有指南意义的规范化治疗方案。目的:综述近年国外关节置换后假体周围感染的研究进展。方法:第一作者应用计算机检索1998至2019年PubMed数据库、Springerlink数据库的相关文章,英文检索词"Joint replacement,Periprosthetic joint infection,Progress in diagnosis and treatment";共检索到400余篇相关文献,50篇文献符合纳入标准。结果与结论:(1)随着新型血清标志物α-防御素和白细胞酯酶及D-二聚体、新型核医学检验方法及利用代谢组学和蛋白质组学等新方法的提出,可以凭借早期感染的生物标志物发现和诊断假体周围感染;(2)此外可以利用新的技术来破坏生物膜、微生物繁殖过程以及定量分子方法来提高病原体鉴定的准确性;(3)随着这些假体周围感染治疗进展的出现,快速、准确、经济的方法可能使明确诊断及培养出致病菌成为一件简单的事,那么很多病例都可以选择一期翻修;如若软组织条件不好或者不满足一期翻修的条件,则可进入二期翻修;(4)明确致病微生物,可以使用敏感的药物进行治疗,为二期翻修做好充足的准备,这对于假体周围感染治疗具有划时代的意义。
