膝关节二期翻修术治疗假体周围感染的疗效分析

The clinical result of two-stage revision to the knee periprosthetic infection

[目的]探讨二期翻修手术治疗膝关节假体周围感染的有效性、失败原因和骨水泥活动间隔物对二期置换术后膝关节功能的影响。[方法]回顾性分析2010年1月~2012年12月因膝关节假体周围感染而行二期翻修手术的病例21例,分析失败原因,比较术前术后患者膝关节评分（KSS）和膝关节活动度。[结果]2例真菌感染病例1例因一期手术后不能控制感染,1例因二期翻修手术后再次发生感染而最终行膝关节融合术。其余19例患者二期手术后平均随访31个月（19~44个月）,二期清创膝关节翻修术获得成功。术后KSS膝关节评分、KSS功能评分和膝关节活动度比术前都有明显提高。[结论]膝关节假体周围感染通过一期清创、带抗生素活动型骨水泥间隔物置入、二期翻修手术可以有效治疗感染并重建膝关节功能,而真菌引起的感染是造成手术失败的原因之一。

[ Objective] To discuss the effectiveness of two- stage revision in treatment of total knee periprothetic infec- tion, and the failure reason as well as the influence of mobilized bone cement spacer to the knee function was also investigated. [ Methods] Twenty- one cases undergoing two- stage knee revision for priprothetie infection from January 2010 to December 2012 were enrolled. The failure reason were analyzed and the Knee Society Score （KSS） and Range of Motion before and after knee revision were recorded and compared. SPSSll. 0 software was used for statistic analysis. [ Results] Infection was found lost control in 2 cases for fungal infection and arthrodesis was given to them. One was re - infection after one stage debridement, and another was re - infection after two stage revision. The average follow up time for another 19 cases was 31 months （range, 19 44 months） . Two -stage revision were successful in all of them. The Knee Society Score and range of motion were improved after revision. [ Conclusion ] The periprothetic infection can be controlled and knee function can be reconstructed by one stage debridement, antibiotic mobilized cement spacer implantation and two - stage knee revision, but pefiprothetic fungal infection is one of the revision failure reasons.