两种间隔器在膝关节置换术后假体感染的二期翻修术中应用的比较和分析

Comparison of two spacer prostheses in two-stage revision of infected total knee arthroplasty

目的比较膝关节置换术后假体感染的二期翻修术中使用的两种不同临时间隔器的临床效果,为临床工作提供参考。方法本研究对1993～2003年间在芬兰坦佩雷大学附属医院使用了两种不同临时间隔器行二期翻修术的32例患者34膝数据进行回顾性分析。结果使用重新消毒假体为间隔期的患膝(Ⅰ组,n=24)与使用仿关节骨水泥间隔器的患膝(Ⅱ组,n=10)进行比较,平均随访32个月,结果显示Ⅰ组的二期翻修手术时间更短[平均(185±33)vs(247±88)min,t=-39.289,P=0.008),失血更少[425(50～2200)vs1500(120～4200)ml,t=-38.342,P=0.008],治疗总时间(一期清创及二期翻修术手术时间总和,P=0.289)和总失血量(P=0.174)间的差异无统计学意义。Ⅰ组有更好的运动范围(89±18)°vs(17±13)°,P<0.001),KSS评分[64(0～78)vs17(1～58),P=0.027]和功能评分[(15±14)vs(4±10),P=0.046]也更高。两组共26例感染得到控制(76%),19例(56%)达到良好的临床效果。1例治疗失败截肢,4例(12%)感染复发。感染复发率两组间无统计学差异。结论膝关节置换假体感染二期翻修术中,重新消毒假体间隔器可以带来更好的运动范围和功能。

Objective To evaluate and compare the effects of two different spacers used in patients who underwent two-stage revisions.Methods In this retrospective study,during 1993-2003 patient records of 34 knees for joint replacement in 32 patients at Coxa Hospital,Tampere,Finland,were reviewed.Two-stage revisions had been carried out in these cases,during which resterilized prosthetic components and cements were used as two different spacers.Results The outcomes of resterilized prosthetic components spacers （Group Ⅰ,n=24） were compared to those of operations performed during the same period of time using cement spacers （Group Ⅱ,n=10）.With an average follow-up of 32 months,the operation time of group Ⅰ was shorter [mean （185±33） vs （247±88） minutes,P=0.008] and there was less blood loss[median 425 （50-2200） vs 1500 （120-4200） millilitres,P=0.008],but there were no signifcant differences in the total operative time （the sum of operative time in 1st and 2nd stage procedures;P=0.289） or the total blood loss （P=0.174）.Patients of group Ⅰ had a wider range of motion [mean （89±18） vs （17±13） degrees,P0.001] than patients with cement spacers.They also tended to score higher in Knee Society knee [median 64 （0-78） vs 17 （1-58）,P=0.027] and function [mean （15 ±14） vs （4±10）,P=0.046] score.The control of infection was achieved in 26 cases with good or excellent clinical outcomes in 19 cases （56%）.Treatment failed and resulted in amputation at thigh before re-implantation in one case.Three patients did not undergo re-implantation.Infection relapsed in four cases （12%）.The reinfection rate did not differ between the two spacer groups.Conclusions Patients treated with resterilized components had superior range of motion values during the interval of the two stages,but with higher infection relapsed rate.We consider resterilized prosthetic components an alternative in the management of infected knee arthroplasties.