全膝关节置换围手术期预防假体感染的研究进展

Research advances on prevention of periprosthetic joint infection after total knee arthroplasty

全膝关节置换术是骨科最常见的手术之一，是治疗膝关节晚期病变最有效的措施，可以矫正关节畸形，恢复关节功能。然而，假体感染是全膝关节置换术后最严重的并发症之一，也是导致膝关节翻修的主要原因。假体感染不仅会增加病死率，而且很难处理，给患者和社会带来了巨大的经济负担。预防是管理假体感染最重要的措施。假体感染的危险因素主要包括术前营养不良、糖尿病、肥胖、吸烟、关节腔注射史、类风湿关节炎等。针对假体感染，围术期可以采取许多预防措施，其中术前预防包括营养支持、控制血糖、戒烟、停用免疫抑制剂、皮肤准备、去除定植菌等；术中预防包括净化手术室环境、预防性应用抗生素、冲洗切口等；术后主要预防措施包括输血管理、伤口敷料的选择、伤口引流等。虽然许多不可控性因素会增加假体感染的风险，但围术期对可控性危险因素的积极干预对降低假体感染率意义重大。本文重点查阅国内外近3年关于膝关节假体感染预防的文献，总结各种因素对假体感染的影响。针对假体感染的预防理念必须贯穿整个围术期，积极的预防措施定能让假体感染率降到最低。因此，本文通过对全膝关节置换围手术期假体感染的预防进行综述，旨在探讨如何降低术后假体感染风险，并为国内外相关研究和l}缶床治疗提供一定参考。

Total knee arthroplasty is one of the most common surgical procedures in the department of orthopedics. It is also the best way to treat end-stage disease of the knees and it corrects joint deformity and improves joint function. Periprosthetic joint infection （PJI） is one of the most devastating complications after total knee arthroplasty. It has also been the main cause for failure of total knee arthroplasty. PJI not only results in substantial patient morbidity, but also is a challenge to the orthopaedic community and it br/ngs a great economic burden to the patients and the society. Prevention is the most important measure to reduce PJI. Malnutrition, diabetes, obesity, smoking, preoperative intra-articular knee injections and rheumatoid arthritis are some of the risk factors of PJI. There are a number of strategies for the prevention of infection during the perioperative period. Preoperative prevention measures include preoperative optimization of malnutrition, glycaemic control, smoking quit, discontinuation of the immunosuppressant, skin preparation, decolonization etc. Intraoperative prevention measures include particle-free operating envi- ronment, administration of prophylactic antibiotics and irrigation; postoperative prevention measures include blood management, wound dressing and wound drainage. Although there are many uncontrollable factors that could increase the risk of PJI, providing positive intervention for those controllable risk factors is significant in reducing PJI. We focus on consulting references at home and abroad about the prevention of knee prosthesis infection in the past three years and summarize the influence of various factors on PJI. The concept of prevention of PJI should run through the whole perioperative period. We believe that positive preventive measures must be able to reduce the rate of PJI to a minimum. Therefore, we review the prevention of PJI during the perioperative period aiming to explore how to reduce the risk of PJI and provide some references to related research and clinical treatment do- mestically and overseas.