摘要
目的评估清创灌洗+碘伏浸泡,保留假体的手术策略治疗急性假体周围感染(PJI)的临床疗效。方法回顾性分析上海长海医院自2011年4月至2015年8月间收治的28例急性PJI的患者,纳入标准:初次人工关节置换术后,通过关节液培养或术中病理确诊为PJI,且发病时间小于4周,未发现窦道形成,排除标准:患者自诉对碘过敏。治疗方法采用在传统清创灌洗,保留假体的基础上,增加碘伏浸泡,时间不少于20 min,术中更换假体可动组件,术后给予足量足疗程抗生素治疗。采用SPSS 20.0软件的重复测量方差分析对手术前后的功能评分进行比较,包括Harris髋关节疼痛与功能评分、纽约特种外科医院(HSS)膝关节疼痛与功能评分和加州大学洛杉矶分校(UCLA)评分。结果平均随访时间(48±16)月,所有28例患者中有25例感染得到控制,在最近的随访中均停用抗生素。其中,12例全髋关节置换(THA)患者Harris评分平均为(94.2±2.3)分,13例全膝关节置换(TKA)患者HSS评分平均为(94.5±2.5)分。感染复发3例均出现在TKA组,后期行两期置换。清创术后与术前比较,Harris评分、HSS评分、和UCLA评分均显著改善(均为P<0.05)。结论与同期单纯采用清创灌洗,保留假体治疗急性PJI的文献结果相比,在传统清创灌洗的基础上增加碘伏浸泡的方法,可能提高急性PJI的感染控制率,但仍需大样本量随访观察。
Objective To evaluate the clinical efficacy of debridement,local application of povidone iodine and retention of prosthesis in the treatment of periprosthetic joint infection（ PJI）.Methods From April 2011 to August 2015,a retrospective analysis including 28 acute PJIs in Changhai Hospital was performed. Inclusion criteria： primary hip or knee replacement,diagnosed PJI through joint fluid culture or intraoperative pathological test,and the onset was less than four weeks,with no sinus formation. The exclusion criteria was the patients complained of iodine allergy. The treatment consisted of debridement and soaked with povidone iodine at least 20. 0 min. The modular part of the joint was exchanged and adequate antibiotics were routinely administrated. SPSS 20 software was used to compare the functional scores before and after the operation with repeated measures analysis of variance. The functional scores including Harris scores,hospital for special surgery（ HSS） scores,and University of California at Los Angeles（ UCLA） scores. Results The mean follow-up period was（ 48 ± 16） months,and 25 of the 28 cases had no evidence of persistent infection and were no longer on antibiotics at the most recent follow-up.The average Harris score was（ 94. 2 ± 2. 3） for the THA group,and the average HSS score was（ 94. 5 ±2. 5） for the TKA group. All the functional scores were significant improved following the debridement compared with the preoperative ones（ all P 0. 05）. All the failures occurred in the TKA group who underwent two stage replacements. Conclusion Compared with the literature results of debridement,retention of prosthesis in the treatment of acute PJI,the addition of local application of povidone iodine may impove the infection control rate,but a large group and long time follow-up is needed.
出处
《中华关节外科杂志（电子版）》
CAS
2017年第4期79-83,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
关键词
关节成形术
置换
感染
清创术
保留假体
聚维酮碘
Arthroplasty
Replacement
Infection
Debridement
Prosthesis retention
Povidone iodine
