有效足量抗生素配合清创手术治疗假体相关感染保留置入假体的疗效分析

Outcome analysis of surgical debridement and antibiotic treatment for prosthetic joint-associated infection with retention of implant

目的探讨髋关节与膝关节置换术后假体感染（PJI）的全身和局部抗生素治疗从而保留置换假体的临床疗效。方法自2010-02—2014-09诊治18例髋关节与10例膝关节置换术后感染,处理前均出现感染症状。对于有窦道患者采用手术清创联合规范足量静脉滴注与口服抗生素治疗,对于单纯红肿渗液无窦道患者,进行静脉滴注联合口服抗生素治疗。结果 28例中2例治疗失败,1例双侧髋关节置换术后感染控制后出院失访,余25例均获得随访4个月-4年,平均38个月,均恢复良好,切口愈合,未再发生感染。髋关节感染患者术前Harris评分为（42.3±23.5）分,术后（78.4±12.0）分,手术前后比较差异有统计学意义（t=5.642,P〈0.001）;膝关节感染患者术前HSS评分为（42.9±12.9）分,术后（68.8±25.7）分,差异有统计学意义（t=2.850,P=0.001）。患者的关节功能和生活质量都得到极大改善,抗生素抗感染治疗成功率和假体保存率92.9%。结论诊断明确的髋膝关节置换术后感染,根据患者创口情况选择性进行清创手术并规范联合应用抗生素治疗,可以达到无需取出置入假体控制感染的目的,获得满意的临床疗效。

Objective To investigate the clinical outcome of antibiotics and debridement for prosthetic joint-associated infection（PJI） with retention of the implant including hip-PJI and knee-PJI. Methods Eighteen patients with hip PJI and 10 with knee PJI from Feb. 2010 to Sept. 2014 were retrospectively evaluated. Surgical debridement and antibiotics were received for treatment of patients with fistula and sinus. The patients without fistula and sinus were treated with antibiotics only.Results A successful treatment outcome was defined as retention of the implant. Two（7%） of these patients led to a failure.The rest 25 patients except for one loss of follow-up with prosthetic joint-associated infection had a follow-up for 4 months to4 years（38 months for average）. All of these 25 patients were free of infection. Harris Hip Scores improved significantly（ t =5.642,P =9.940） from a mean of（42.3 ±23.5） preoperatively to（78.4 ±12） at final clinical assessment, and HSS scores increased significantly（t =2.850,P =0.001） from（42.9±12.9） to（68.8±25.7）. The rate of implant retention was 92.9%. After the treatment, the joint function and the quality of life of the patients were improved. Conclusion Surgical debridement and systematical antibiotics for well-diagnosed PJI are effective for prevention of infection and retention of the implant.