人工髋膝关节置换术后假体周围慢性感染病原菌培养方法及结果分析

The method and result analyses of pathogenic bacteria culture on chronic periprosthetic joint infection after total knee arthroplasty and total hip arthroplasty

目的 分析人工髋、膝关节置换术后假体周围慢性感染病原菌培养方法及效果.方法 回顾性分析自2010年9月至2014年3月收治的全膝关节置换术（TKA）及全髋关节置换术（THA）术后被明确诊断为假体周围慢性感染的23例患者资料.其中TKA 15例,THA 8例;男性12例,女性11例;年龄32 ～ 79岁,平均62岁;伴有窦道患者9例.患者均在关节腔穿刺前至少2周停用抗生素治疗,翻修术前及术中分别取关节液予以病原菌培养及药敏试验.术中组织行一般病原菌培养及病理活检,培养结果为阴性的样本延长培养时间至2周.结果 本组患者共23例,术前培养1周阳性率30.4％ （7/23）,阴性样本延长至2周阳性率39.1％（9/23）.术中培养1周阳性率60.9％（14/23）,阴性样本延长至2周阳性率82.6％（19/23）,7例（30.4％）术前及术中培养结果相符.结论 对TKA、THA术后假体周围慢性感染行病原菌培养,在明确诊断前应停用抗生素至少2周.

Objective To analyze the results of pathogenic bacteria culture on chronic periprosthetic joint infection after total knee arthroplasty （TKA） and total hip arthroplasty （THA）.Methods The medical data of 23 patients with chronic periprosthetic joint infection after TKA or THA from September 2010 to March 2014 were reviewed.Fifteen cases of TKA and 8 cases of THA were included in this study.There were 12 male and 11 female patients with the mean age of 62 years （range from 32 to 79 years）,and among them 9 patients with sinus.All patients discontinued antibiotic therapy for a minimum of 2 weeks before arthrocentesis,taking pathogenic bacteria culture and antimicrobial susceptibility test by using synovial fluid taken preoperatively and intraoperatively of revision.Common pathogenic bacteria culture and pathological biopsy were taken on tissues intraoperatively of revision.Culture-negative specimens were prolonged the period of incubation for 2 weeks.Results The overall culture-positive rate of all 23 patients for 1 week before revision was 30.4% （7/23）,and the positive rate of culture-negative samples which prolonged for 2 weeks was 39.1% （9/23）.The overall culture-positive rate of patients for 1 week intraoperatively of revision was 60.9% （14/23）,and the positive rate of culture-negative samples which prolonged for 2 weeks was 82.6% （19/23）.The incubation results of 7 cases （30.4%） preoperatively conformed to that of intraoperation.Conclusion The culture-positive rate of pathogenic bacteria culture can be increased evidently by discontinuing antimicrobial therapy for a minimum of 2 weeks prior to the definite diagnosis.