【摘要】 目的探讨人工膝关节翻修术治疗初次置换术后假体周围感染的治疗方法选择、围手术期要点和早期临床疗效。方法 2009年7月至2016年6月对华中科技大学同济医学院附属武汉中心医院骨外科9例初次人工膝关节置换术后符合美国骨肌感染协会假体周围感染定义的患者进行翻修术,其中女6例,男3例;平均年龄(65±6)岁。2例行一期翻修术,7例行二期翻修术。所有翻修术均使用含抗生素骨水泥。二期翻修术中3例为全抗生素骨水泥关节型占位器,4例为全抗生素骨水泥非关节型占位器。采用配对t检验对术前及术后末次随访的患膝评分和活动范围进行比较。结果 9例患者均获得随访,平均随访时间为(28±25)个月。关节活动范围术前为(43±5)°,术后(87±20)°,差异有统计学意义(t=-96.6,P<0.01)。疼痛视觉模拟评分术前为(3±2)分,术后(7±2)分,差异有统计学意义(t=-11.3,P<0.01)。美国特种外科医院膝关节评分术前为(42±10)分,术后末次随访时为(84±5)分(t=-127.4,P<0.01)。无1例出现感染复发。结论应用人工膝关节翻修术是治疗初次置换术后膝关节假体周围感染的有效方法,术前仔细的病情评估及正确手术方案选择、术中彻底的感染病灶清理及合适抗生素骨水泥占位器应用、术后规范的抗感染治疗是获得较满意早期疗效的必要条件。更多还原

【Abstract】 Objective To investigate treatment options and perioperative points of revision for periprosthetic joint infection following primary total knee arthroplasty(TKA) and to analyse the short term clinical outcome retrospectively. Methods A series of nine patients(six women and three men) who met the definition of periprosthetic joint infection by the Musculoskeletal Infection Society following primary TKA and received revision in department of orthopaedics,the Central Hospital of Tongji Medical College were reviewed from July 2009 to June 2016. The mean age was(65 ± 6) years. Two cases received single-stage revision and seven cases received two-stage revision. Antibiotic-loaded cement was used in all the revision.Three cases were mobile knee spacers and four cases were static knee spacers in two-stage revision. Paired ttest was used to compare the preoperative and the last follow-up postoperative mean scores and range of motion of affected knee. Results All the patients were followed up for an average of(28 ± 25) months. The range of motion was(43 ± 5) ° preoperatively and(87 ± 20) ° postoperatively(t =-96. 6,P < 0. 01). The visual analogue scale was(3 ± 2) preoperatively and(7 ± 2) postoperatively(t =-11. 3,P < 0. 01). The Hospital for Special Surgery score improved significantly from(42 ± 10) preoperatively to(84 ± 5) at the last follow-up(t =-127. 4,P < 0. 01). None of the patients with revision developed recurrence of infection. Conclusion Revision is effective in the treatment of periprosthetic joint infection following primary TKA; careful preoperative assessment in accordance with the condition of the patients and correct operative options,thorough debridement at infected lesions and appropriate application of antibiotic-loaded cement spacers,and standard postoperative anti-infection treatment are the necessary conditions to obtain satisfactory short term clinical effects.更多还原