摘要
目的探讨更换股骨假体联合硫酸钙抗生素载体的旷置方法在全膝关节置换术(TKA)后假体周围感染(PJI)治疗中的可行性。方法回顾性分析2017年5月至2020年1月期间郑州大学第一附属医院骨科收治的35例TKA后PJI患者资料。男12例,女23例;年龄为49~84岁,平均67.9岁。所有患者均采用更换股骨假体联合抗生素硫酸钙载体的旷置方法。记录术后微生物培养情况及一期旷置前和二期翻修前的血白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP),并比较术前与末次随访时关节活动度(ROM)、美国特种外科医院(HSS)膝关节评分和美国膝关节协会(KSS)评分。结果术后微生物培养阳性13例(37.1%),阴性22例(62.9%)。其中金黄色葡萄球菌4例,表皮葡萄球菌2例,光滑念珠菌2例,近平滑念珠菌2例,白色念珠菌、类结核杆菌和大肠埃希菌各1例。WBC、ESR和CRP分别由一期旷置前的平均13.67×10^(9)/L、49.71 mm/h、45.13 mg/L下降至二期翻修前的6.44×10^(9)/L、18.79 mm/h、7.82 mg/L。所有患者术后获平均22.4个月(8~41个月)随访。ROM、HSS评分、KSS评分分别由旷置术前的73.2°±15.9°、(59.5±14.6)分、(36.1±6.0)分提高至末次随访时105.6°±13.2°、(84.3±10.0)分、(86.1±5.6)分,以上项目旷置术前与末次随访时比较差异均有统计学意义(P<0.05)。所有患者末次随访时无一例患者出现再次感染迹象。结论对于TKA后PJI患者,采用更换股骨假体联合硫酸钙抗生素载体的旷置方法可以取得较好的感染控制效果,有利于术后关节活动度及功能恢复。
Objective To investigate the feasibility of replacing the femoral prosthesis and implanting antibiotic calcium sulfate carriers in a two-stage revision for periprosthetic infection following total knee arthroplasty(TKA).Methods Between May 2017 and January 2020,35 patients were admitted to Department of Orthopaedic Surgery,The First Affiliated Hospital to Zhengzhou University for periprosthetic infection after TKA.They were 12 males and 23 females,aged from 49 to 84 years(average,67.9 years).The two-stage revision for periprosthetic infection was performed for all of them and replacement of femoral prosthesis and implantation of antibiotic calcium sulfate carriers were carried out in stage-one revision.Recorded were postoperative culture of micro-organisms,white blood cell count(WBC),erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)before stage-one and stage-two revisions;the Hospital for Special Surgery(HSS)knee score,range of motion(ROM)and American Knee Society Score(KSS)were compared between preoperation and the last follow-up.Results Postoperative negative culture was found in 22 cases(62.9%),and positive one in 13 cases(37.1%)of which 4 were caused by Staphylococcus aureus,2 by Staphylococcus epidermidis,2 by Candida glabrata,2 by Candida parapsilosis,one by Candida albicans,one by Mycobacterium tuberculosis and one by Escherichia coli.WBC,ESR and CRP decreased on average from 13.67×10^(9)/L,49.71 mm/h and 45.13 mg/L before stage-one revision to 6.44×10^(9)/L,18.79 mm/h and 7.82 mg/L before stage-two revision.All patients were followed up for an average of 22.4 months(from 8 to 41 months).At the last follow-up,ROM,HSS and KSS were significantly increased from preoperative 73.2°±15.9°,59.5±14.6 and 36.1±6.0 to 105.6°±13.2°,84.3±10.0 and 86.1±5.6,respectively(P<0.05).None of the patients showed any sign of re-infection at the last follow-up.Conclusion For patients with periprosthetic infection following total knee arthroplasty,replacing femoral prosthesis and implantation of antibiotic calcium sulfate carriers can well control infection,facilitating recovery of range of motion and function after surgery.
作者
谭俊
曹福洋
江旭
杨猛
于洋
常英健
许建中
Tan Jun;Cao Fuyang;Jiang Xu;Yang Meng;Yu Yang;Chang Yingjian;Xu Jianzhong(Department of Orthopaedic Surgery,The First Affiliated Hospital to Zhengzhou University,Medical School of Zhengzhou University,Zhengzhou 450002,China)
出处
《中华创伤骨科杂志》
CAS
CSCD
北大核心
2021年第5期389-394,共6页
Chinese Journal of Orthopaedic Trauma
关键词
关节成形术
置换
膝
假体相关感染
硫酸钙
翻修术
旷置术
Arthroplasty,replacement,knee
Prosthesis-related infections
Calcium sulfate
Revision
Stage one revision
