全膝关节置换术后感染行旷置术的体会

Experience on space technique of treating postoperative infection of TKA

目的探讨全膝关节置换(TKA)术后感染行旷置术的手术技术对控制感染的临床效果。方法1997年2月至2009年4月对13例TKA术后感染患者行旷置术的手术技术及术后对感染的控制效果进行回顾性分析。所有患者均采用一期假体取出、彻底清创、抗生素骨水泥旷置的手术方法,分析旷置前及旷置后3～6个月时的血沉、CRP及核素骨扫描。结果旷置后3～6个月时,13例患者的血沉和CRP均降至正常范围,核素骨扫描显示无明显浓聚,均需再次进行翻修手术并取得满意效果。所有患者共发生2例术中并发症,其中主要为髌韧带自胫骨结节或髌骨下极撕脱。结论感染TKA旷置术中安全移除假体、彻底清创等手术技术的改进和提高,是控制感染并成功进行翻修手术的关键步骤。

Objective To discuss the technique about debridement and prosthesis removal of two-stage revision to treat infected total knee arthroplasty. Methods Thirteen cases of infected TKA from February 1997 to April 2009 were reviewed about the effect of debridement and prosthesis removal of two-stage revision. All cases had been performed debridement, prostehsis removal and antibiotic-impregnated cement spacer. Erythrocyte sedimentation rate and C-reactive protein of pre- and post-operation were analyse. Every case received nuclear scan pre-and post-operation. Results Erythrocyte sedimentation rate and C-reactive protein decreased to nomal range in all 13 cases 3 to 6 months post-operation. All cases successfully received two-stage reimplantations without infection. There were two complications occurred in operation including rupture of patellar tendon from the inferior patellar or tibial tubercle. Conclusions The improvement of the technique of debridement and prosthesis removal is crucial to successful treat the infected TKA.