切换至 "中华医学电子期刊资源库"
高级检索
中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2018, Vol. 12 ›› Issue (02) : 284 -289. doi: 10.3877/cma.j.issn.1674-134X.2018.02.025

所属专题： 文献；

临床经验

人工膝关节翻修术治疗初次置换术后假体周围感染的早期临床疗效
李舰1,†(), 张卫国1, 蒋林1, 柳昊1, 周忠1, 徐钧1   
  1. 1. 430014　武汉，华中科技大学同济医学院附属武汉中心医院（武汉市中心医院）骨外科
  • 收稿日期:2017-02-16 出版日期:2018-04-01
  • 通信作者: 李舰
  • 基金资助:
    武汉市卫计委科研项目(WX16C49)

Short term clinical outcome of revision for treatment of periprosthetic joint infection following primary total knee arthroplasty

Jian Li1,†(), Weiguo Zhang1, Lin Jiang1, Hao Liu1, Zhong Zhou1, Jun Xu1   

  1. 1. Department of Orthopaedics, the Central Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, China
  • Received:2017-02-16 Published:2018-04-01
  • Corresponding author: Jian Li
  • About author:
    Corresponding author: Li Jian, Email:
全文 ( ) 下载PDF ( ) 导出引用
引用本文：

李舰, 张卫国, 蒋林, 柳昊, 周忠, 徐钧. 人工膝关节翻修术治疗初次置换术后假体周围感染的早期临床疗效[J]. 中华关节外科杂志(电子版), 2018, 12(02): 284-289.

Jian Li, Weiguo Zhang, Lin Jiang, Hao Liu, Zhong Zhou, Jun Xu. Short term clinical outcome of revision for treatment of periprosthetic joint infection following primary total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2018, 12(02): 284-289.

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。

关键词: 再手术, 假体相关感染, 膝关节假体, 疗效
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 t-test 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.

Key words: Reoperation, Prosthesis-related infections, Knee Prosthesis, Treatment outcome
图1 典型病例右侧膝关节假体翻修术前后X线片。图A　翻修术前右膝正侧位X线片，示股骨侧假体已松动，胫骨侧假体无明显松动；图B　第1次翻修术后右膝正侧位X线片，示原肿瘤膝关节假体已完全取出，同时植入非关节型占位器；图C　为第2次翻修术后右膝正侧位X线片，示临时占位器已取出，二期翻修植入新的膝关节假体
[1]
Carr AJ, Robertsson O, Graves S, et al. Knee replacement[J]. Lancet, 2012, 379(9823):1331-1340.
[2]
Parvizi J, Adeli B, Zmistowski B, et al. Management of periprosthetic joint infection: the current knowledge: AAOS exhibit selection[J/OL]. J Bone Joint Surg Am, 2012, 94(14):e104(1-9)．
[3]
Kuzyk PR, Dhotar HS, Sternheim A, et al. Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes[J]. J Am Acad Orthop Surg, 2014, 22(3):153-164.
[4]
Jiranek WA, Waligora AC, Hess SR, et al. Surgical treatment of prosthetic joint infections of the hip and knee: changing paradigms？[J]. J Arthroplasty, 2015, 30(6):912-918.
[5]
Chiu FY, Lin CF. Antibiotic-impregnated cement in revision total knee arthroplasty. A prospective cohort study of one hundred and eighty-three knees[J]. J Bone Joint Surg Am, 2009, 91(3):628-633.
[6]
Mittag F, Leichtle CI, Schlumberger M, et al. Clinical outcome after infected total knee and total hip arthroplasty [J]. Acta Ortop Bras, 2016, 24(1):43-47.
[7]
Haddad FS, Sukeik M, Alazzawi S. Is single-stage revision according to a strict protocol effective in treatment of chronic knee arthroplasty infections？[J]. Clin Orthop Relat Res, 2015, 473(1):8-14.
[8]
陈曦，吕厚山，孙铁铮．人工全膝关节翻修术中期随访结果[J]．中华外科杂志，2015，53(10):757-762.
[9]
Hoell S, Sieweke A, Gosheger G, et al. Eradication rates, risk factors, and implant selection in two-stage revision knee arthroplasty: a mid-term follow-up study[J]. J Orthop Surg Res, 2016, 11(1):93-98.
[10]
周勇刚，肖逸鹏，王岩，等．二期翻修在人工膝关节置换术后感染治疗中的作用[J/CD]．中华关节外科杂志(电子版)，2007，1(4):206-210.
[11]
Lichstein P, Su S, Hedlund H, et al. Treatment of periprosthetic knee infection with a two-stage protocol using static spacers[J]. Clin Orthop Relat Res, 2016, 474(1):120-125.
[12]
Jämsen E, Sheng P, Halonen P, et al. Spacer prostheses in two-stage revision of infected knee arthroplasty[J]. Int Orthop, 2006, 30(4):257-261.
[13]
Freeman MG, Fehring TK, Odum SM, et al. Functional advantage of articulating versus static spacers in 2-stage revision for total knee arthroplasty infection[J]. J Arthroplasty, 2007, 22(8):1116-1121.
[14]
Park SJ, Song EK, Seon JK, et al. Comparison of static and Mobile antibiotic-impregnated cement spacers for the treatment of infected total knee arthroplasty[J]. Int Orthop, 2010, 34(8):1181-1186.
[15]
Hsieh PH, Huang KC, Lee PC, et al. Two-stage revision of infected hip arthroplasty using an antibiotic-loaded spacer: retrospective comparison between short-term and prolonged antibiotic therapy[J]. J Antimicrob Chemother, 2009, 64(2):392-397.
[16]
Wang QJ, Shen H, Zhang XL, et al. Staged reimplantation for the treatment of fungal peri-prosthetic joint infection following primary total knee arthroplasty[J]. Orthop Traumatol Surg Res, 2015, 101(2):151-156.
[17]
Cha MS, Cho SH, Kim DH, et al. Two-Stage total knee arthroplasty for prosthetic joint infection[J]. Knee Surg Relat Res, 2015, 27(2):82-89.
[18]
Parvizi J, Jacovides C, Antoci V, et al. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme[J]. J Bone Joint Surg Am, 2011, 93(24):2242-2248.
[19]
Hoell S, Borgers L, Gosheger G, et al. Interleukin-6 in two-stage revision arthroplasty: what is the threshold value to exclude persistent infection before re-implanatation？[J]. Bone Joint J, 2015, 97-B(1):71-75.
[20]
Shafafy R, Mcclatchie W, Chettiar K, et al. Use of leucocyte esterase reagent strips in the diagnosis or exclusion of prosthetic joint infection[J]. Bone Joint J, 2015, 97B(9):1232-1236.
[21]
Stroh DA, Johnson AJ, Naziri Q, et al. Discrepancies between frozen and paraffin tissue sections have little effect on outcome of staged total knee arthroplasty revision for infection[J]. J Bone Joint Surg Am, 2012, 94(18):1662-1667.
[22]
Feldman DS, Lonner JH, Desai P, et al. The role of intraoperative frozen sections in revision total joint arthroplasty[J]. J Bone Joint Surg Am, 1995, 77(12):1807-1813.
[1] 李培杰, 乔永杰, 张浩强, 曾健康, 谭飞, 李嘉欢, 王静, 周胜虎. 细菌培养阴性的假体周围感染诊治的最新进展[J]. 中华关节外科杂志(电子版), 2023, 17(06): 827-833.
[2] 张华, 孙宇, 乡世健, 李樱媚, 王小群. 循环肿瘤细胞预测晚期胃肠癌患者化疗药物敏感性的研究[J]. 中华普通外科学文献(电子版), 2023, 17(06): 422-425.
[3] 莫波, 王佩, 王恒, 何志军, 梁俊, 郝志楠. 腹腔镜胃癌根治术与改良胃癌根治术治疗早期胃癌的疗效[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 644-647.
[4] 索郎多杰, 高红桥, 巴桑顿珠, 仁桑. 腹腔镜下不同术式治疗肝囊型包虫病的临床疗效分析[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 670-673.
[5] 唐浩, 梁平, 徐小江, 曾凯, 文拨辉. 三维重建指导下腹腔镜右半肝加尾状叶切除治疗Bismuth Ⅲa型肝门部胆管癌的临床研究[J]. 中华普外科手术学杂志(电子版), 2023, 17(06): 688-692.
[6] 顾睿祈, 方洪生, 蔡国响. 循环肿瘤DNA检测在结直肠癌诊治中的应用与进展[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 453-459.
[7] 邰清亮, 施波, 侍新宇, 陈国梁, 陈俊杰, 武冠廷, 王索, 孙金兵, 顾闻, 叶建新, 何宋兵. 腹腔镜次全结肠切除术治疗顽固性慢传输型便秘的疗效分析[J]. 中华结直肠疾病电子杂志, 2023, 12(06): 478-483.
[8] 徐红莉, 杨钰琳, 薛清, 张茜, 马丽虹, 邱振刚. 体外冲击波治疗非特异性腰痛疗效的系统评价和Meta分析[J]. 中华老年骨科与康复电子杂志, 2023, 09(05): 307-314.
[9] 梁文龙, 曹杰, 黄庆, 林泳, 黄红丽, 杨平, 李冠炜, 胡鹤. 信迪利单抗联合瑞戈非尼治疗晚期结直肠癌的疗效与安全性分析[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 409-413.
[10] 高显奎, 赵太云, 陆兴俊, 张洪领, 房修罗, 闫碧春, 王胤, 王永翠, 刘苗苗, 冉若男. 内镜电凝止血与组织胶注射治疗上消化道溃疡伴出血的疗效观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 452-455.
[11] 姜里蛟, 张峰, 周玉萍. 多学科诊疗模式救治老年急性非静脉曲张性上消化道大出血患者的临床观察[J]. 中华消化病与影像杂志(电子版), 2023, 13(06): 520-524.
[12] 张景旭, 李德舫, 由上可, 张玉田. 贝伐珠单抗与安罗替尼联合奥沙利铂治疗晚期直肠癌的临床疗效[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 289-293.
[13] 杨镠, 秦岚群, 耿茜, 李栋庆, 戚春建, 蒋华. 可溶性免疫检查点对胃癌患者免疫治疗疗效和预后的预测价值[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 305-311.
[14] 盛静, 梅勇, 夏佩, 王晓林. 乌苯美司联合伊立替康二线治疗晚期胃癌的临床研究[J]. 中华消化病与影像杂志(电子版), 2023, 13(05): 317-321.
[15] 李莹倩, 李华山. 基于真实世界的完全性直肠脱垂治疗方式评价[J]. 中华临床医师杂志(电子版), 2023, 17(06): 700-705.
阅读次数
全文


摘要

版权所有 中华医学会 中华医学电子音像出版社有限责任公司  京ICP备14006079号-1  网络出版服务许可证：(署)网出证(京)字第075号