[1]王相选,李文波,方心俞,等.老年人工关节感染患者留置骨水泥间隔器的临床疗效分析[J].中华老年骨科与康复电子杂志,2019,(06):306-311.[doi:10.3877/cma.j.issn.2096-0263.2019.06.001]
 Wang Xiangxuan,Li Wenbo,Fang Xinyu,et al.Clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection[J].Chin J Geriatr Orthop Rehabil(Electronic Edition),2019,(06):306-311.[doi:10.3877/cma.j.issn.2096-0263.2019.06.001]
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老年人工关节感染患者留置骨水泥间隔器的临床疗效分析()
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中华老年骨科与康复电子杂志[ISSN:1674-3911/CN:11-9292/R]

卷:
期数:
2019年06期
页码:
306-311
栏目:
关节
出版日期:
2019-12-05

文章信息/Info

Title:
Clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection
作者:
王相选1李文波2方心俞2黄子达2张文明2
350122 福州,福建医科大学研究生院1;350005 福州,福建医科大学附属第一医院关节外科2
Author(s):
Wang Xiangxuan1 Li Wenbo2 Fang Xinyu2 Huang Zida2 Zhang Wenming2
1Graduate College of Fujian Medical University, Fuzhou350122, China; 2Department of Orthopedics, the First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
关键词:
老年人 感染 人工关节 间隔器 留置
Keywords:
Aged Infection Joint prosthesis Spacers Retention
DOI:
10.3877/cma.j.issn.2096-0263.2019.06.001
文献标志码:
A
摘要:
【摘要】 目的 评估老年人工关节感染患者采用二期翻修治疗,第一阶段术后留置骨水泥间隔器的临床疗效。方法 回顾性收集福建医科大学附属第一医院有完整随访资料的留置骨水泥间隔器的老年人工关节感染患者17例,男性8例,女性9例,患者年龄60~88岁,平均年龄(73±8)岁;髋关节11例,膝关节6例;16例检出病原菌;15例使用关节型间隔器,2例使用非关节型间隔器,留置骨水泥间隔器的时间为6~69个月。记录患者生存状况、术后感染控制、功能恢复以及再次手术情况;采用Harris评分及KSS评分评价末次随访时的关节功能,并采用疼痛视觉模拟评分(VAS)评价关节疼痛情况。结果 17例患者均获得随访,随访时间6~69个月,平均(28±15)个月。健在患者16例(16/17,94.1%),已故患者1例(1/17,5.9%)。15例健在患者感染控制(15/16,93.7%),1例(1/16,6.3%)患者因感染持续而移除间隔器,4(4/17,23.6%)例患者术后进行额外清创手术,2例(2/17,11.8%)出现并发症。除去已故及关节旷置患者外,其余15例患者末次随访时髋关节Harris评分为(82±4)分;膝关节KSS评分为(79.8±2.6)分;VAS评分为(1.0±0.9)分(0~4分)。结论 对于老年人工关节感染患者,彻底清创后留置关节型骨水泥间隔器感染控制高、功能恢复良好。
Abstract:
Objective To evaluate the clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection. Methods Seventeen retention prosthetic bone cement spacers elderly patients with periprosthetic joint infection with complete data were included in the present study. There were 8 males and 9 females, aged 60-88 years, average age was (73±8) years old, including 11 hips, 6 knee joints, thus 16 pathogens were detected, 15 cases used joint spacers, 2 cases used non-articular spacers. The time for indwelling the cement spacer was 6 to 69 months. Patient survival, postoperative infection control, functional recovery, and reoperation were recorded. Harris score and KSS score were used to evaluate joint function at the last follow-up, and pain visual analogue scale (VAS) was used to evaluate joint pain. Results All patients were followed up for 6 to 69 months with an average of (28±15) months. There were 16 patients (16/17, 94.1%) and 1 patient (1/17, 5.9%). The remaining 15 patients had infection control (15/16, 93.7%), 1 patient (1/16, 6.3%) had spacers removed due to persistent infection, and 4 (4/17, 23.6%) patients had additional postoperative debridement operation, 2 (2/17, 11.8%) cases had complications. Except for the patients with decomposed and articular dislocation, the other 15 patients had a Harris score of (82±4) at the last follow-up, the KSS score of the knee was (79.8±2.6), the VAS score was (1.0±0.9)(0 to 4 points). Conclusion Retention bone cement spacers can be obtained satisfactory infection control and functional recovery after debridement in elderly patients with periprosthetic joint infection

参考文献/References:

1 Mahmud T, Lyons MC, Naudie DD, et al. Assessing the Gold standard: a review of 253 two-stage revisions for infected TKA [J]. Clin Orthop Relat Res, 2012, 470(10): 2730-2736.
2 Lu J, Han J, Zhang C, et al. Infection after total knee arthroplasty and its gold standard surgical treatment: Spacers used in two-stage revision arthroplasty [J]. Intractable Rare Dis Res, 2017, 6(4): 256-261.
3 Cui Q, Mihalko WM, Shields JS, et al. Antibiotic-impregnated cement spacers for the treatment of infection associated with total hip or knee arthroplasty [J]. J Bone Joint Surg Am, 2007, 89(4): 871-882.
4 Gomez MM, Tan TL, Manrique J, et al. The fate of spacers in the treatment of periprosthetic joint infection [J]. J Bone Joint Surg Am, 2015, 97(18): 1495-1502.
5 Petis SM, Perry KI, Pagnano MW, et al. Retained antibiotic spacers after total hip and knee arthroplasty resections: high complication rates [J]. Journal of Arthroplasty, 2017, 32(11): 3510-3518.
6 Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty [J]. J Bone Joint Surg Am, 2003, 85-A Suppl 1: S75-80.
7 Parvizi J, Gehrke T. International consensus on periprosthetic joint infection: let cumulative wisdom be a guide [J]. J Bone Joint Surg Am, 2014, 96(6): 441.
8 Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the Workgroup of the Musculoskeletal Infection Society [J]. Clin Orthop Relat Res, 2011, 469(11): 2992-2994.
9 Hoiby N, Bjarnsholt T, Moser C, et al. ESCMID guideline for the diagnosis and treatment of biofilm infections 2014 [J]. Clin Microbiol Infect, 2015, 21Suppl: S1-25.
10 Diaz-Ledezma C, Higuera CA, Parvizi J. Success after treatment of periprosthetic joint infection: a delphi-based international multidisciplinary consensus [J]. Clin Orthop Relat Res, 2013, 471(7): 2374-2382.
11 Kini SG, Gabr A, Das R, et al. Two-stage Revision for Periprosthetic Hip and Knee Joint Infections [J]. Open Orthop J, 2016, 10: 579-588.
12 Veltman ES, Moojen DJ, Glehr M, et al. Similar rate of infection eradication for functional articulating, prefabricated and custom-made spacers in 2-stage revision of the infected total hip: a literature review [J]. Hip Int, 2016, 26(4): 319-326.
13 Romanò CL, Gala L, Logoluso N, et al. Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers [J]. Knee Surg Sports Traumatol Arthrosc, 2012, 20(12): 2445-2453.
14 Burnett R S J , Clohisy J C , Barrack R L, et al . Antibiotic Cement Spacers in Total Hip and Total Knee Arthroplasty: Problems, Pitfalls, and Avoiding Complications[M]// Infection and Local Treatment in Orthopedic Surgery. Springer Berlin Heidelberg, 2007.
15 Choi HR, Freiberg AA, Malchau H, et al. The fate of unplanned retention of prosthetic articulating spacers for infected total hip and total knee arthroplasty [J]. J Arthroplasty, 2014, 29(4): 690-693.
16 Marczak D, Synder M, Sibinski M, et al. Two stage revision hip arthroplasty in periprosthetic joint infection. Comparison study: with or without the use of a spacer [J]. Int Orthop, 2017, 41(11): 2253-2258.
17 Nguyen M, Sukeik M, Zahar A, et al. One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections [J]. Open Orthop J, 2016, 10: 646-653.
18 Oussedik SI, Dodd MB, Haddad FS. Outcomes of revision total hip replacement for infection after grading according to a standard protocol [J]. J Bone Joint Surg Br, 2010, 92(9): 1222-1226.
19 Zahar A, Kendoff DO, Klatte TO, et al. Can good infection control be obtained in one-stage exchange of the infected TKA to a rotating hinge design? 10-year results [J]. Clin Orthop Relat Res, 2016, 474(1): 81-87.
20 Marang-van de Mheen PJ, Bragan Turner E, Liew S, et al. Variation in Prosthetic Joint Infection and treatment strategies during 4.5 years of follow-up after primary joint arthroplasty using administrative data of 41397 patients across Australian, European and United States hospitals [J]. 2017, 18(1): 207.
21 曹力, 阿斯哈尔江, 张晓岗, 等. 一期翻修术治疗全膝关节置换术后感染 [J]. 中华骨科杂志, 2011, 31(2): 131-136.
22 彭慧明, 翁习生, 张笑, 等. 一期翻修术治疗全膝关节置换术后假体周围感染的中长期随访结果[J].中华外科杂志, 2017, 55(3): 233-236.
23 Huang R, Hu CC, Adeli B, et al. Culture-negative periprosthetic joint infection does not preclude infection control[J]. Clin Orthop Relat Res, 2012, 470(10): 2717-2723.
24 白国昌, 曾慧意, 李文波, 等. 超声裂解在人工关节置换术后假体周围感染诊断中的作用 [J]. 中华骨科杂志, 2014, 34(6): 659-663.
25 Fang XY, Li WB, Zhang CF, et al. Detecting the presence of bacterial DNA and RNA by polymerase chain reaction to diagnose suspected periprosthetic joint infection after antibiotic therapy [J]. Orthop Surg, 2018, 10(1): 40-46.
26 王启金, 黄子达, 方心俞, 等. 二代测序技术在人工关节感染关节液病原菌检测中的应用[J]. 中华骨科杂志, 2018, 38(11): 658-665.

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备注/Memo

备注/Memo:
基金项目:福建省自然科学基金对外合作项目(2018I0006);福建省自然科学基金高校产学合作项目(2018Y4003)
更新日期/Last Update: 2019-12-11