中国修复重建外科杂志

中国修复重建外科杂志

保留假体清创术治疗人工关节置换术后假体周围感染的临床研究

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目的探讨应用保留假体清创术治疗人工全髋关节置换术(total hip arthroplasty,THA)及人工全膝关节置换术(total knee arthroplasty,TKA)后假体周围感染(periprosthetic joint infection,PJI)的中期疗效以及导致清创失败的危险因素。方法回顾分析 2011 年 1 月—2015 年 1 月,应用保留假体清创术治疗的 45 例 THA 及 TKA 后 PJI 患者临床资料。男 19 例,女 26 例;年龄 23~78 岁,平均 58.4 岁。THA 16 例,TKA 29 例。40 例为初次关节置换术后、5 例为翻修术后发生感染。关节置换或者翻修术至出现感染症状时间为 0.5~72.0 个月,平均 15.5 个月;出现感染症状至该次清创时间为 3~270 d,平均 35 d。早期感染 13 例,急性血源性感染 24 例,晚期感染 8 例。X 线片检查显示假体未见异常。术前关节液细菌培养提示,17 例阴性、28 例阳性。12 例患者原手术切口周围存在与关节腔相通窦道。记录患者住院时间,髋、膝关节功能评分,感染愈合情况;统计学分析影响感染治疗效果的危险因素。结果患者住院时间 5~79 d,平均 22.6 d。患者术后均获随访,随访时间 24~74 个月,平均 52 个月。末次随访时,THA 患者髋关节 Harris 评分及 TKA 患者膝关节美国特种外科医院(HSS)评分均明显高于术前,差异有统计学意义(P<0.05)。术后 33 例感染控制,感染治愈率为 73.3%。单因素分析显示,感染症状持续时间、术前窦道形成是影响感染治疗效果的可能因素(P<0.05);多因素分析显示,术前窦道形成是其危险因素(P<0.05)。结论保留假体清创术联合足量抗生素治疗 THA 及 TKA 术后 PJI,可以达到控制感染、避免翻修的目的。对于已形成窦道、感染症状持续 14 d 以上的患者清创后感染复发的风险较高。

ObjectiveTo investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness.MethodsA clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed. There were 19 males and 26 females with a mean age of 58.4 years (range, 23-78 years). PJI occurred after primary joint arthroplasty in 40 cases and after revision in 5 cases. The mean time interval between the performance of infection symptoms and the arthroplasty or revision was 15.5 months (range, 0.5-72.0 months). The time interval between the performance of infection symptoms and debridment was 35 days (range, 3-270 days). There were early postoperative infections in 13 cases, acute hematogenous infections in 24 cases, and late chronic infections in 8 cases. X-ray films showed that the location of prosthesis was good. The results of bacilli culture showed that 28 cases were positive and 17 were negative. Twelve cases had sinuses. Length of stay, Hospital for Special Surgery (HSS) score, and Harris score were recorded to evaluate risk factors by using a multivariate logistic regression.ResultsThe mean length of stay was 22.6 days (range, 5-79 days). All patients were followed up 24-74 months (mean, 52 months). There were 33 cases that retained the prosthesis without further evidence of infection with the success rate was 73.3%. There were significant differences in Harris score and HSS score between pre- and post-operation (P<0.05). The univariate analysis results showed that the failure of debridement with prosthesis retention had a significant correlation with sinus developing and duration of infection symptoms more than 14 days (P<0.05). Multivariate logistic regression analysis results showed that sinus developing was an independent risk factor of failure (P<0.05).ConclusionDebridement with prosthesis retention plays an important role in treating PJI after THA and TKA. These patients with sinus performing and duration of infection symptoms more than 14 days have higher risk to develop infection again.

关键词: 人工全髋关节置换术; 人工全膝关节置换术; 假体周围感染; 清创术; 并发症; 影响因素

Key words: Total hip arthroplasty; total knee arthroplasty; periprosthetic joint infection; debridement; complication; influence factor

引用本文: 宋兴桂, 李昕, 宋俊雷, 徐驰, 李睿, 李恒, 陈继营. 保留假体清创术治疗人工关节置换术后假体周围感染的临床研究. 中国修复重建外科杂志, 2018, 32(6): 685-693. doi: 10.7507/1002-1892.201711105 复制

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