采用二期翻修置换治疗TKA术后膝关节假体周围感染

Two-stage revision for treating periprosthetic infection following total knee arthroplasty

目的探讨采用二期假体翻修置换治疗人工全膝关节置换（TKA）术后假体周围感染的疗效。方法对5例（5膝）TKA术后出现假体周围感染患者行二期假体翻修置换术：一期清创后．置人抗生素骨水泥旷置，术后使用6周敏感抗生素，停药后连续2次穿刺培养细菌阴性，C反应蛋白（CRP）和血沉（ESR）逐步下降至正常后行二期假体置换，并用抗生素骨水泥固定。结果术后5例均获平均随访20（3—36）个月，均无感染复发。HSS评分由术前平均38（10—60）分提高至术后6周的78（65—84）分，末次随访时HSS评分平均82（65—88）分，膝关节活动度平均86。（60—100。）。结论二期假体翻修置换可以彻底清除感染灶，并使膝关节获得良好的功能。是治疗TKA术后假体周围感染的有效方法。

Objective To study the clinical results of the two-stage revision in the treatment of periprosthetic infection following total knee arthmplasty （TKA）. Methods Five cases of peripmsthetie infection following TKA were treated with two- stage revision. The knee joint were fdlad with antibiotic-cement spacer following the primary debridement. During the interval, effective intravenous antibiotics were administered for 6 weeks. Following two times of the knee joint puncture negative results in culture were got, C-reactive protein（CRP）and ESR decreased gradually to normal,then a new prosthesis was implanted with antibiotic-cement. Results All the cases were followed up for 3-36 months （averaged 20 months）. No recurrent infection was found in 5 cases. The mean HSS was improved from 38 points（10-60 points） before operation to 78 points（65-84 points） at the 6 months postoperatively. The mean HS$ was 82 points （65-88 points） at last time follow-up. The mean range of motion of the knee joint was 86-（60-100）. Conclusion The two-stage revision is an effective procedure for the peripmsthetie infection following TKA. It can improve the knee function and eliminate the infection.