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中华关节外科杂志(电子版)

中华关节外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (04) : 497 -501. doi: 10.3877/cma.j.issn.1674-134X.2022.04.019

临床经验

清创保留假体联合抗生素治疗膝关节置换术后急性感染
周胜虎1, 李峰2, 程永刚3, 刘浩1, 张浩强1, 甄平1, 乔永杰1,†()   
  1. 1. 730050　兰州，解放军联勤保障部队第九四〇医院关节外科
    2. 733000　武威，解放军联勤保障部队第九四三医院骨科
    3. 455000　安阳地区医院
  • 收稿日期:2021-11-16 出版日期:2022-08-01
  • 通信作者: 乔永杰
  • 基金资助:
    甘肃省重点研发计划(21YF5FA154); 甘肃省青年科技基金(20JR5RA588); 甘肃省青年科技基金(21JR7RA014); 部队专项培育项目(2021YXKY014)

Debridement and implant retention combining antibiotics in treatment of acute infection following total knee arthroplasty

Shenghu Zhou1, Feng Li2, Yonggang Cheng3, Hao Liu1, Haoqiang Zhang1, Ping Zhen1, Yongjie Qiao1,†()   

  1. 1. The 940th Hospital of Joint Logistics Support Force of PLA, Lanzhou 730050, China
    2. The 943rd Hospital of Joint Logistics Support Force of PLA, Wuwei 733000, China
    3. Anyang Regional Hospital 3, Anyang 455000, china
  • Received:2021-11-16 Published:2022-08-01
  • Corresponding author: Yongjie Qiao
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引用本文：

周胜虎, 李峰, 程永刚, 刘浩, 张浩强, 甄平, 乔永杰. 清创保留假体联合抗生素治疗膝关节置换术后急性感染[J]. 中华关节外科杂志(电子版), 2022, 16(04): 497-501.

Shenghu Zhou, Feng Li, Yonggang Cheng, Hao Liu, Haoqiang Zhang, Ping Zhen, Yongjie Qiao. Debridement and implant retention combining antibiotics in treatment of acute infection following total knee arthroplasty[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2022, 16(04): 497-501.

目的

探讨采用清创保留假体联合抗生素(DAIR)治疗人工膝关节置换术后急性期感染的临床疗效。

方法

回顾性分析解放军联勤保障部队第九四〇医院关节外科自2008年12月1日至2018年11月30日收治的，根据美国肌肉与感染协会(MSIS)诊断标准确诊为急性人工关节感染(PJI)的26例膝关节置换术后急性感染患者的临床资料。所有患者均采用一期彻底清创，更换膝关节聚乙烯衬垫，术后膝关节腔持续冲洗引流及足疗程敏感抗生素治疗。用t检验比较患膝术前、术后的膝关节疼痛视觉模拟评分(VAS评分)，美国特种外科医院膝关节评分(HSS评分)，入院及末次随访红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-6(IL-6)。

结果

纳入26例患者，失访3例，随访时间平均(44±28)个月。其中治愈17例，感染控制率73.9%。术后的膝关节VAS评分较术前降低(t＝24.815，P<0.05)，术后的HSS评分较术前升高(t＝41.966，P<0.05)。末次随访ESR(t＝14.140)、CRP(t＝3.503)、IL-6(t＝2.999)均较入院时降低(均为P<0.05)。

结论

DAIR治疗人工膝关节置换术后急性感染，严格把握手术时机及手术适应证，可有效控制感染，恢复关节功能，临床效果满意。

关键词: 关节成形术，置换，膝, 感染, 清创术, 假体保留
Objective

To evaluate the clinical efficacy of debridement, antibiotics, and implant retention (DAIR) in the treatment of acute infection after total knee arthroplasty.

Methods

A retrospective analysis of the joint surgery of the 940th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from December 1, 2008 to November 30, 2018, was diagnosed with acute prosthetic joint infection (PJI) cases according to the diagnostic criteria of the American Society for Musculoskeletal Infection (MSIS), a total of 26 clinical data of patients with infection after acute knee arthroplasty. All the patients were treated with one-stage thorough debridement, replacement of knee joint polyethylene pads, postoperative wound irrigation and drainage, and adequate treatment with sensitive antibiotics. The pain visual analogue scale (VAS), Hospital for Special Surgery (HSS) score of the knee, sedimentation rate (ESR), C-reactive protein (CRP), interleukin (IL) -6 before and after the knee surgery were compared by t test.

Results

Twenty-six patients were enrolled, three cases were lost during the follow-up, and the follow-up time was (44±28) months. Among them, 17 cases were cured, the infection control rate was 73.9%.The postoperative knee joint VAS score was lower than that before surgery (t=24.815, P<0.05), and the postoperative HSS score was higher than that before surgery (t=41.966, P<0.05). ESR(t=14.140), CRP(t=3.503), and IL-6 (t=2.999)at last follow-up were all lower than those at admission (all P<0.05).

Conclusion

Controlling the timing of surgery and the indications for surgery strictly, DAIR can control the acute infections after total knee arthroplasty effectively, restore joint function, and obtain satisfactory clinical results.

Key words: Arthroplasty, Infection, Debridement, Prothesis retention
表1 患者术前及术后VAS评分、膝关节HSS评分比较[n＝26，(±s)]
项目 VAS评分 HSS评分
术前 6.0±1.2 35.6±4.3
末次随访 2.0±0.7 86.4±4.7
t值 24.815 41.966
P值 <0.001 <0.001
表2 患者术前及术后血清炎性标志物比较[n＝26，(±s)]
项目 ESR(mm/h) CRP(mg/dL) IL-6(ng/L)
术前 59.7±21.5 4.0±1.6 26.3±44.7
末次随访 15.6±7.8 1.6±0.5 2.6±1.6
t值 14.140 3.503 2.999
P值 <0.001 0.002 0.009
图1 典型病例患者左膝骨关节炎行膝关节表面置换术前后情况。图A为术前左膝关节正侧位X线片，示假体在位，无松动表现；图B为术后复查左膝关节正侧位X线片，示假体在位，无松动表现；图C为术后2周左膝关节外观，示局部肿胀伴活动受限；图D术中情况，可见大量坏死组织，感染严重；图E~F为假体周围病变组织病理HE染色(×100)，示化脓性炎症；图G为术后6个月复查膝关节正侧位X线片，示假体在位，无松动表现
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