抗生素骨水泥间隔体在全膝关节置换术后感染二期翻修中的应用

Antibiotic-loaded articulating cement spacer in two-stage revision for infected total knee arthroplasty

目的总结关节型抗生素骨水泥间隔体技术治疗全膝关节置换术后迟发深部感染的技术要点与初步经验。方法2006年1月至2009年2月接受二期翻修治疗的全膝关节置换术后迟发深部感染患者21例（21膝），男8例，女13例；年龄56-83岁，平均64．4岁。一期手术中彻底清创，取出假体，植入含高浓度万古霉素的关节型骨水泥间隔体；术后静脉滴注敏感抗生素2-8周．感染控制后二期植入翻修假体。结果全部患者获得随访，随访时间17-54个月，平均32．2个月。无一例出现感染复发。终末随访时，KSS膝关节评分、功能评分、疼痛评分及膝关节活动范围均较术前明显改善，伸膝迟滞程度无明显加重。两次手术间隔平均11．5周。间隔体取出前后骨缺损程度未见明显改变。治疗期间未见明显肝、肾功能异常及伤口愈合不良、深静脉血栓形成、肺栓塞、心脑血管意外等并发症。结论应用关节型抗生素骨水泥间隔体技术可在一定程度上保持间隔期内的膝关节功能、避免骨量丢失．相关并发症少。彻底清创、间隔期内使用敏感抗生素、准确判断翻修假体植入时机是治疗成功的关键。

Objective To detail our early experience on a modified two-stage revison using articu-lating antibiotic-loaded cement spacer （AALCS） for late periprosthetic infection of total knee arthroplasty （TKA）. Methods From January 2006 to February 2009, a series of 21 patients （21 knees） underwent two- stage revision knee arthroplasty for late infected TKA. There were 8 males and 13 females, aged from 56 to 83 years （average, 64.4 years）. In the first stage, each patient underwent radical debridement, removal of all components and cement, and implantation of articulating cement spacer containing vancomycin. Graduated knee motion and partial weight bearing activity were encouraged in the interval period. Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 weeks （range, 2-8 weeks） followed by a second-stage revision TKA. All the patients were regularly followed-up using the American Knee Society Scoring System. Results All patients were followed up for 17 to 54 months （average, 32.2 months）. At final follow-up, the knee society score, function score, pain score and range of motion fROM） of knee were signifi-cantly improved compared with those before operation. Meanwhile, there was no significant increase in the degree of extension lag. The average interval period was 11.5 weeks （range, 6-32 weeks）. No change of bone defect volume was found between two stages. There were no complications such as recurrent infection, hepat- ic and renal dysfunction, and deep venous thrombosis. Conclusion Treating infected TKA with AALCS can avoid spacer-related bone loss, preserve knee function between two stages, and eradicate infection effectively without significant complications. The early clinical results are inspiring. Radical debridement, individual application of systemic antibiotics, and reasonable juncture for the second revision are all key factors related to a successful outcome.