二期翻修在人工膝关节置换术后感染治疗中的作用

The role of two-stage TKA revision in the treatment of infected total knee arthroplasty

目的探讨二期翻修手术治疗人工膝关节置换术后感染的有效性、第二期翻修时机的选择及抗生素使用的时间。方法采用二期翻修术治疗了19例膝关节置换术后感染患者,6例采用金属灌注冲洗型占位器,13例采用抗生素骨水泥占位器,其中2例为非关节型占位器,3例为部分抗生素骨水泥关节型占位器,8例为全抗生素骨水泥关节型占位器。术后定期随访,应用X线片及HSS评分进行评价。结果所有患者均获得随访,平均随访时间21个月(3～36个月),HSS评分由术前平均42.5分提高到最后复查时的88.6分,患者满意率为89.5%。在最后随访时没有感染复发的病例。结论二期翻修手术是治疗人工髋关节置换术后感染的有效方法,临时占位器起到重要的作用,使用关节型抗生素骨水泥占位器有控制感染效果好、术后抗生素使用时间短、术后功能恢复好及术后不用灌注的优点。

Objective To investigate the efficacy of two-stage TKA revision in the treatment of infected total knee arthroplasty, the optimal length of the interval period between the two operations, and the optimal length of antibiotic usage. Methods A total of 19 patients were treated with two-stage revision. The metasl-perfusion-irrigating spacer was used in 6 cases, then the antibiotic-bone cement spacer was used in the other 13 cases. The outcome was evaluated by using the HSS score system and the X-ray. Results All patients were followed up clinically and radiographically for an average of 21 months（3 -36 months） . No infection reoccurrence was found after the final revisions. The mean postoperative HSS Score was increased from 42. 5 points preoperation to 88.6 postoperation. The satisfactory rate of the patients was 89.5%. None case with recurring infection had been found in the last followed-up research. Conclusion The two-stage revision is effective in the treatment of infected knee arthroplasty. The temporal spacer played a great role in the procedure. Full antibiotic loaded cement articulating spacer has many advantages over other types of spacer.