自制活动型抗生素骨水泥间隔器:在全膝关节表面置换后感染翻修中的应用

Self-made active antibiotic bone cement spacer: revision for infection after total knee arthroplasty

背景:关节置换的主要目的是为了缓解关节疼痛,恢复关节功能,提高患者生活质量。但是置换后出现关节感染是灾难性的,随着关节置换技术的日益成熟,关节置换后假体周围感染率已明显下降。目的:观察自制活动型抗生素骨水泥间隔器在全膝关节表面置换后感染翻修中的应用效果。方法:新疆维吾尔自治区人民医院自2006年1月至2012年12月共收治22例全膝关节表面置换后感染患者,女14例,男8例,年龄66-81岁,平均69.5岁。明确诊断后给予翻修处理,如考虑一期翻修,取出原有假体,使用抗生素骨水泥,再次安装;如选择二期翻修,则在清创同时将自制活动型抗生素骨水泥间隔器放入股骨及胫骨处,待6个月-1年感染控制后再考虑安放翻修假体。于翻修后随访,行纽约特种外科医院膝关节功能评分。结果与结论:所有患者均获随访,随访时间1-60个月。治疗后2例单纯清创患者和1例一期翻修患者感染复发,给予二期翻修处理,均无神经血管损伤、假体脱位、松动和下肢深静脉血栓形成,达到感染治愈标准。末次随访纽约特种外科医院膝关节功能评分58-86分,平均(70.2±0.4)分。提示全膝关节表面置换后需根据相应病情及感染不同时期,选择正确治疗方法根治感染,尽力保留关节功能,提高患者生活质量。

BACKGROUND：The purpose of total knee arthroplasty is to relieve the pain of joint, to restore the function of joint, and to elevate the quality of life of patients. If infection happened, for the patient it is disaster and for surgeon it is failure. As the development of technique, infection rate surrounding the prosthesis has lowered apparently after replacement. OBJECTIVE：To observe application effect of self-made active antibiotic bone cement spacer in the revision of total knee arthroplasty infection. METHODS：A total of 22 patients who had infection after total knee arthroplasty were treated in the Xinjiang Uygur Autonomous Region People’s Hospital from January 2006 to December 2012, including 14 females and 8 males, at the age of 66-81 years old, averagely 69.5 years. After definitive diagnosis, revision was performed. If one-stage revision should be conducted, original prosthesis should be removed, and antibiotic bone cement was used for second fixation. If two-stage revision should be conducted, self-made active antibiotic bone cement spacer should be placed in femur and tibia during debridement. When infection was control ed after 6 months to 1 year, the prosthesis was considered to be placed. Fol ow-up was conducted after revision. New York Hospital for Special Surgery knee score was used. RESULTS AND CONCLUSION：Al patients were fol owed up for 1 to 60 months. After treatment, two cases of debridement alone and one case of one-stage revision affected infection recurrence, and underwent two-stage revision. They did not suffer from neurovascular injury, prosthesis dislocation, loosening or deep vein thrombosis, and reached the standard of infection cure. At final fol ow-up, Hospital for Special Surgery score was 58-86, averagely （70.2±0.4）. These results indicated that after total knee arthroplasty, correct therapeutic method should be selected to treat infection according to corresponding patient’s condition and different stages of infection. Joint function should be retained as much as possible so as to improve quality of life of patients.