高风险人群膝关节置换术后感染的原因分析及处理对策

Analysis and treatment of infection after knee replacement in high-risk patients

目的探讨高风险人群膝关节置换术后感染的原因及处理对策。方法对1998年1月～2003年12月进行膝关节置换术的7例高风险人群(出现术后感染者)进行回顾性分析调查,针对术前、术中、术后不同时期的治疗流程中可能引起感染的原因进行分析,并就治疗效果随访调查。结果7例患者中,2例保留假体、清创冲洗;2例清创并假体取出,抗生素骨水泥填塞,其中1例行二期关节再置换术;1例行关节融合术;2例截肢。随访(31.9±8.4)个月,除1例行关节融合术的糖尿病患者感染迁延外,无再发感染病例。结论高风险人群膝关节置换术后,除具有一般全膝关节置换术所存在的易感因素外,其切口大、手术时间长、软组织损伤重、假体占位体积大、免疫功能低下是造成感染的高危因素,及早清创、假体取出、严重者果断截肢方可有效控制感染。

Objective To explore the cause and treatment of infection after knee replacement in high -risk patients. Methods Seven high - risk patients with infection after knee replacement from January 1998 to December 2003, were selected retrospectively to analyze the possible cause of infection perioperatively, and evaluated the effect of treatment. Results Of the 7 cases,simple debridement and antibiotic treatment were prescribed for 2 patients, debridement and two - stage reimplantation for 1, debridement and two - stage joint fusion for 1. Two cases were amputation, 1 case was filled with cement in the joint after put out the implant. All of the 7 patients were followed up on average of （ 31.9 ± 8.4 ） months. No infection recurred except one of arthredesis with diabetes. Conclusion Besides the predisposing factors of common patients, the high - risk of knee replacement include long incision, more opera- tive duration, severe trauma and low immunological function, which put the patients at high - risk of infection. Suitable method should be taken according to patients, condition. The severe one should be amputa- tion without hesitate.