人工全膝关节置换术后感染的临床分析

Clinical analysis of 13 infected total knee replacements

目的 探讨全膝关节置换术后感染的原因、处理方法及临床效果。 方法 对 1987年～ 1999年 13例全膝关节置换术后感染患者的病因以及清创、一期或二期再置换等治疗方法进行总结分析。 13例患者术前膝关节平均活动度为 5 5°,HSS评分为 36 5分 ;平均随访 3年 5个月。 结果 13例感染患者经治疗后均未复发 ,80 %的患者对手术满意 ;膝关节活动度恢复至平均 85° ,HSS评分为73 5分。 结论 类风湿关节炎 (RA)、服用激素、合并糖尿病、使用铰链式假体及初次置换术前膝关节曾行其它手术是膝关节术后感染的高危因素 ;感染明确后 ,应积极进行清创合并应用敏感抗生素 ;

ObjectiveTo investigate the cause, treatment and its result of infected total knee replacements (TKRs). Methods Between 1987 and 1999, 13 infected TKRs in 13 patients were treated with surgical debridement and one stage or two stage reimplantation. The preoperative average ROM of knees was 55° and the average Hospital for Special Surgery(HSS) knee score was 36 5 points. Clinical results were evaluated after average follow up for 3 years and 5 months. We analyzed the factors for TKR infection. Results No recurrent infection was noted, and pain was significantly alleviated in all patients. The average ROM of knees was 85° and the average HSS knee score was 73 5 points. Conclusions The high risk factors for TKR infection are rheumatoid arthritis, steroid administration, associated diabetes mellitus, hinged prosthesis and previous knee surgery. Early surgical debridement with intravenous antibiotics is necessary as soon as deep infection is detected. Two stage reimplantation is more effective in eradicating deep infection than single debridement or one stage reimplantation.