【摘要】 背景:二期翻修是治疗人工膝关节置换后感染的有效方法。但如何控制感染,保存关节间隙,避免软组织挛缩,同时不加重骨组织缺损是难题之一。目的:观察具有关节作用的抗生素骨水泥隔体在人工膝关节置换后感染二期翻修中的作用。设计、时间及地点:回顾性病例分析,2003-01/2006-06在天津医院关节中心进行。对象:人工膝关节置换后慢性感染患者10例,其中男3例,女7例;年龄59～75岁,平均66岁。方法:一期手术彻底清创,取出假体,置入具有关节作用的抗生素骨水泥隔体,隔体置入后患者部分负重,关节屈伸活动。选用敏感抗生素静脉滴注6周,感染控制后再置入假体。主要观察指标:材料与宿主的生物相容性,膝关节评分。结果:从取出到再置假体时间为12～20周,平均15周。再置假体后复查无感染复发,未见假体松动。所有患者均未发现与隔体相关的骨折、脱位及不稳定。再置假体之前最后一次复查,膝关节屈曲平均66°,平均膝关节功能评分从翻修前的30分增加到93分,平均膝关节疼痛评分从翻修前的45分增加到95分。结论:膝关节置换后感染二期翻修过程中采用具有关节作用的抗生素骨水泥隔体,既能彻底清除感染,又能保存关节间隙,减轻关节囊及韧带挛缩,保持屈伸间隙平衡,为再置假体创造有利条件。更多还原

【Abstract】 BACKGROUND: Two-stage revision is an effective method of treating total knee replacement. But,how to control infection,keep joint space,avoid soft tissue contraction and relieve bone tissue defect is a difficult problem. OBJECTIVE: To observe the effect of bone cement spacer with antibiotics in two-stage revision following infected total knee replacement. DESIGN,TIME AND SETTING: The retrospective case analysis was performed at the Joint Center,Tianjin Hospital from January 2003 to June 2006. PARTICIPANTS: Ten chronic infection patients,comprising 3 males and 7 females,aged 59-75 years,averagely 66 years,were enrolled following total knee replacement. METHODS: In the one-stage surgery,patients were fully debrided. After prothesis was removed,bone cement spacer with antibiotics was implanted. Patients were weight loading,the joint did flexion-extension movements. Patients received sensitive antibiotics via intravenous drip for 6 weeks. Prothesis was reimplanted after controlling infection. MAIN OUTCOME MEASURES: Biocompatibility between materials and the host; knee score. RESULTS: The interval from removal of prosthesis to re-implantation was averagely 15 weeks (12-20 weeks). None of them developed re-infection after revision total knee replacement. There were no prothesis loose,and no cases of fracture,dislocation,instability associated with articulating cement spacer. At the time of the last follow-up before re-implantation,the average knee flexion was 66°. The mean knee society function score had improved from 30 points before revision to 93 points after re-implantation. The mean knee society pain score had improved from 45 points before revision to 95 points after re-implantation. CONCLUSION: Chronic infected knee replacement can be successfully treated by two-stage replacement with articulating spacer,articulating spacer can keep joint space,relieve joint capsule and ligament contract,keep balance of flexion and extension space and facilitate re-implantation.更多还原