12例感染性人工膝关节二期翻修的体会

Experience of 12 Cases of Infectious Artificial Knee Joint Second Overhaul

目的 探讨二期翻修术治疗感染性人工膝关节的疗效。方法 2010年9月至2013年9月采用二期翻修术治疗12例（12膝）人工膝关节置换术后假体周围感染。一期彻底清创,采用抗生素骨水泥spacer,应用敏感抗生素6周。待实验室检查明确感染获得控制后,进行二期翻修,二期翻修术后随访2-5年（平均2.7年）,对患肢关节活动度进行1989年美国膝关节协会评分（American Knee Society Score,AKS评分）,采用VAS（Visual Analogue Scale,VAS）评分法分别测定患者静息痛。结果 12例患者均获得随访,随访时间2-5年（平均2.7年）,所有患者静息痛、关节肿胀、皮温升高等症状消失,截止最后一次随访未见感染迹象,1例患者需使用拐杖辅助行走余均可自助行走,步态基本正常。无1例出现膝关节屈伸功能受限,膝关节活动度AKS评分由治疗前（18.70±1.48）上升到（24.01±1.18）。术前进系统VAS评分治疗前（3.00±0.87）下降到（1.23±1.01）,患者满意率为90.3%。结论 对于染性人工膝关节行一期清创骨水泥spacer,采用敏感抗生素持续应用6周,二期翻修可以获得较为满意的临床疗效。

Objective To study the phase ii revision procedures curative effect for the treatment of infective artificial knee joint. Methods Between September 2010 and September 2010, 12 cases treatment was divided into two stages （12） around the artificial knee joint replacement prosthesis after infection. Issue of thorough debridement, USES the antibiotic bone cement spacer, application of sensitive antibiotic six weeks. Stay clear after infection control laboratory, in two stages, phase ii revision surgery were followed up for 2-5 years （average 2.7 years）, was carried out on the limb joint activity in 1989, the knee society score （American Knee Society Score, AKS scoring）, USES the VAS （Visual Analogue Scale, VAS） resting pain patients with grading method, respectively. Results 12 patients were followed up, the follow-up time of 2-5 years （average 2.7 years）, all patients resting pain, joint swelling, skin temperature rise higher symptoms disappear, as of the last follow-up did not see signs of infection, 1 case of patients need to use crutches auxiliary walk walk all can self-help, basic normal gait. No functional limitations, 1 case in knee joint flexion and extension AKS score before the treatment knee joint mobility （18.70±1.48） to （24.01±1.18）. Preoperative VAS score before treatment into system （3.00±0.87） down to （1.23±1.01）, patients satisfaction rate of 90.3%. Conclusion For dyeing artificial knee joint bone cement spacer line issue of debridement, the sensitive antibiotics application 6 weeks continuously, second phase renovation can obtain satisfactory clinical effect.