保留假体清创治疗人工膝关节置换术后感染的作用

Role of debridement and retention of prosthesis in treating infection after total knee replacement

[目的]探讨保留假体清创在治疗人工膝关节置换术后感染中的可行性、适应证、成功和失败的相关因素以及注意事项.[方法]回顾分析本院自1990～2004年收治的人工膝关节置换术后感染病例,发现9例病人在治疗开始时曾尝试采用清创灌注冲洗的方法保留假体,对这9例病人进行总结,并对可能影响清创是否成功的因素进行统计学分析.[结果]本组9例病人中4例保留了假体,平均随访18个月（10～25个月）,感染均无复发.由于病例数较少,本研究针对可能影响清创成功的因素未能得出有意义的统计学结果,但从结果看：急性感染清创容易成功,而慢性感染则很难获得成功;表皮葡萄球菌成功率较高,金黄色葡萄球菌均失败;表面膝置换成功率较高,而铰链膝置换则难以获得成功;出现症状后应该抓紧时间进行清创,延误的时间越长,成功的可能性越低.[结论]保留假体清创在人工膝关节置换术后感染的治疗中有一定的应用价值,对于术后急性感染病人和术后晚期急性血源性感染病人应尝试进行保留假体清创治疗,但必须严格掌握手术时机及适应证才能获得成功.

[ Objective] To review our experience in treatine infection after total knee arthroplasty with debridement and component retention to determine To the feasibility, indication, factors related to success and failure, and the main points of technique. [ Method] Since 1990 to 2004, 9 patients were treated with debridement and component retention at our department. [ Resuit] Four of 9 patients successfully retained their component at most recent follow-up, without ongoing infection （mean 18 months, range 10 - 25 months）. We have not draw the statistically significant factors that related to successful and failure, but the factors such as acute infection, surfacing replacement, immediate debrided after onset of symptoms, and the bacteria sensitive to antibiotic were relate to success. [ Conclusion] Debridement .and component retention can be used in acute postoperative infection and later acute hematogenous infection after total knee replacement, but timing and indication must be chosen strictly.