人工全膝关节置换术后深部感染的治疗

Treatment of Deep Infection After Total Knee Arthroplasty

目的探讨人工全膝关节置换术后深部感染的治疗方法和临床效果。方法1994～2003年对9例人工全膝关节置换术后深部感染患者分别采用抗生素治疗;关节镜下清创、灌洗;切开清创、灌洗;清创后一期假体再置换;清创后二期假体再置换等不同治疗方法。对以上治疗方法采用自身前后对照的方法进行回顾性分析,HSS膝评分标准评估临床治疗效果。结果3例抗生素治疗,2例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例关节镜下清创、灌洗治疗,1例治愈,1例感染未控制,改行关节切开清创、灌洗治愈;2例清创后一期假体再置换治愈;2例清创后二期假体再置换治愈。9例均获随访,平均随访51.2个月,均无感染复发。HSS膝评分由38分(21～52分)增加至74分(53～85分),膝关节平均活动度由45°(20°～108°)增加至80°(60°～105°)。结论每一种治疗方法都有其适应证和优缺点,应根据具体病情选择合理治疗方法。关节镜下清创损伤小,可最大程度恢复关节功能,但其彻底性不如切开清创,二期假体再置换临床治疗效果可靠。

Objective To treat the deep infection after total knee arthroplasty.Methods From 1994 to 2003,9 patients with deep infection after total knee arthroplasty were treated by administration of antibiotics,arthroscopic debridement combined with irrigation,open debridement combined with irrigation,and one-stage or two-stage reimplantation.All the treatments were retrospectively analyzed by self-comparison.The clinical results were evaluated by hospital for special surgery(HSS)knee score.Results Two of the three patients treated by administration of antibiotics were cured.The failed one was cured by open debridement combined with irrigation.One of the two patients treated by arthroscopic debridement combined with irrigation recovered well,the other one was cured by open debridement combined with irrigation later.Two patients treated by open debridement and one-stage reimplantation healed well.Two patients treated by open debridement and two-stage reimplantation healed well too.All the patients were followed up by an average of 51.2 months.No infection recurred.The HSS knee score was improved from 38 points (21～52 points) to 74 points (53～85 points).The mean motion range of knees was increased from 45°(20°～108°) to 80°(60°～105°).Conclusion There are indications,advantages and disadvantages for any one of the treatment methods.Choice should be made according to the patient's condition.Debridement with arthroscopy has minimized trauma and better function recovery of knee.However,the open debridement and 2-stage reimplantation is more complete and reliable.