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中华关节外科杂志(电子版) ›› 2026, Vol. 20 ›› Issue (04) : 515 -520. doi: 10.3877/cma.j.issn.1674-134X.2026.04.015

个案报道

减张缝合联合中医护理治疗假体周围感染1例
梁宁罡, 武墨轩, 李虎†()   
  1. 100044 北京大学人民医院关节病诊疗研究中心
  • 收稿日期:2026-01-04 出版日期:2026-08-01
  • 通信作者: 李虎

Case report on tension-reducing suturing combined with traditional Chinese medicine nursing for periprosthetic joint infection

Ninggang Liang, Moxuan Wu, Hu Li†()   

  • Received:2026-01-04 Published:2026-08-01
  • Corresponding author: Hu Li
引用本文:

梁宁罡, 武墨轩, 李虎. 减张缝合联合中医护理治疗假体周围感染1例[J/OL]. 中华关节外科杂志(电子版), 2026, 20(04): 515-520.

Ninggang Liang, Moxuan Wu, Hu Li. Case report on tension-reducing suturing combined with traditional Chinese medicine nursing for periprosthetic joint infection[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(04): 515-520.

图1 左膝TKA(全膝关节置换术)术后早期切口愈合过程。图A为术后第4天,膝关节切口皮缘颜色发暗,见少量渗液,提示局部血运障碍;图B为给予患膝局部加压包扎处理;图C为术后第15天,切口渗出消失,愈合良好
图2 左膝迟发性假体周围感染大体图及X线片。图A为术后7个月外伤后膝关节陈旧性瘢痕处窦道,可见皮肤软组织缺损及脓性分泌物;图B为左膝正侧位X线片,示膝关节假体位置良好,未见假体松动或移位征象
图3 左膝改良钢丝橡胶管减张缝合术治疗及愈合图。图A为术中彻底清创后,采用钢丝橡胶管减张缝合技术闭合高张力切口;图B~D为术后随访期间,示减张装置有效分散了切口边缘张力,皮缘对合良好,未见组织坏死;图E为拆除减张缝线后,可见遗留的线孔;图F为伤口完全愈合,软组织覆盖满意
图4 左膝关节感染复发期软组织病变及影像学检查。图A为出院2个月后左膝髌韧带区域可见一约3.0 cm×4.0 cm的软组织肿块隆起;图B左膝正侧位X线片示假体位置稳定;图C为第3次入院时,肿块范围扩大、皮肤菲薄并破溃,可见黄色脓性分泌物;图D为双膝三时相骨扫描,示左膝关节假体周围放射性异常浓聚
图5 联合中医特色护理干预改善左膝局部微循环。图A为在膝关节伤口周围皮肤实施刮痧治疗,促进局部瘀血消散;图B为在患膝周围实施刺络拔罐治疗,通过负压效应改善软组织血流灌注,排出暗红色积血约10 ml
图6 中医特色护理联合抗感染治疗后的伤口外观(出院前),示患者左膝关节坏死组织完全脱落,新鲜肉芽组织生长良好并覆盖创面,伤口无渗出
图7 DAIR(保留假体清创术)术后2年随访时的左膝外观 注:示膝关节前方伤口已完全愈合,遗留陈旧性瘢痕;原病灶及瘢痕周围皮肤可见大面积弥漫性、网状色素沉着,未见窦道开口及感染复发迹象
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