老年人工全膝关节置换术后早期感染的治疗研究

Study on treatment of early infections in the elderly patients after total knee joint arthroplasty

目的探讨老年人工全膝表面关节置换术后早期感染(术后2～3周之内发生的感染)新的治疗方法,以达到早期愈合。方法从1998-2012年5所医院骨科治疗的全膝关节置换术569例患者中选取术后早期感染的老年病例19例(均为全膝表面关节置换),采用手术清创、术后放疗,应用抗菌药物和营养支持等综合方法治疗。结果该治疗组全部按上述方法治疗,其中15例患者保留假体成功,8个月后功能良好,活动度达到0～95度,4例患者采用上述综合方法治疗后感染未能有效控制,再次清创后取出假体,以关节型妥布霉素骨水泥垫圈和串珠植入8～10周后行膝关节翻修术。结论该方法对老年人工全膝表面关节置换术后早期感染,是一种保留假体的基础上临床治疗的有益探索。

OBJECTIVE To explore a new method for the treatment of early infections in the elderly patients after the total knee arthroplasty so as to promote the healing in the early stage. METHODS A total of 569 cases of patients , who underwent the total knee arthroplasty in the orthopedics departments of five hospitals during 1998-2012 , were enrolled in the study, among which 19 cases of elderly patients with postoperative early infections （total knee arthroplasty ） were extracted. The debridement, postoperative radiotherapy , use of antibiotics ,and nutrition support were adopted for the treatment. RESULTS All the patients were treated in accordance to the methods mentioned above, among which 15 cases reserved the artificial prosthesis successfully, with the limb function good after 8 months, and the activity ranging from 0° to 95°. The infections in 4 cases of patients were failed to be effectively controlled, the prosthesis was removed after the debridement for the second time, and the knee arthroplasty was performed 8-10 weeks after the joint type of tobramycin bone cement washer and beads were implanted. CONCLUSION This treatment method may be a clinical treatment beneficial to the patients with early infections after the total knee joint arthroplasty , based on the retention of prosthesis.