保留假体清创术在膝关节假体周围感染中的应用

Application of debridement and implant retention in periprosthetic infection of knee joint

目的探讨保留假体清创结合抗生素骨水泥间质体填充及负压封闭引流技术辅助治疗膝关节置换术后假体周围感染的疗效。方法选取2014年6月至2019年6月收治的12例膝关节置换术后假体周围感染的病历资料,男女各6例;平均年龄(60±9)岁。所有患者均行膝关节彻底清创,取出聚乙烯衬垫,使用万古霉素骨水泥间质体填充,负压封闭引流技术(VSD),术后生理盐水持续冲洗1周为一周期,待感染控制后取出间质体更换同种型号衬垫并关闭术口。术后使用万古霉素稀释后关节腔注射,并复查白细胞、降钙素原、血沉、C-反应蛋白检测感染控制情况。采用独立样本t检验分析比较术前及术后3个月视觉模拟评分法(VAS)、美国特种外科医院膝关节评分(HSS)评估患者症状改善及功能恢复情况。结果所有患者经过3~4周治疗,术口均甲级愈合,复查白细胞、降钙素原、血沉、C-反应蛋白等指标逐渐恢复正常。出院后患者均获得12~60个月随访,平均(30.1±17.8)个月。患者均无感染复发或新的感染,术后3月VAS评分及HSS评分[VAS评分(1.1±1.0)分;HSS评分(87.3±5.4)分]与治疗前相比[VAS评分(5.5±1.4)分;HSS评分(43.0±16.2)分]相比明显改善(t=8.713,P<0.05;t=8.970,P<0.05)。结论保留假体清创结合抗生素骨水泥间质体填充及负压封闭引流技术在治疗膝关节置换术后假体周围感染中能够有效控制感染且保留良好的关节功能。

Objective To investigate the effect of debridement and implant retention with antibiotic bone cement interstitial filling and vacuum sealing drainage in the adjuvant treatment of periprosthetic joint infection after total knee arthroplasty,so as to provide reference for clinical treatment.Methods Twelve cases of periprosthetic joint infection after total knee arthroplasty from June 2014 to June 2019 were selected,including six males and six females,aged from 43 to 72 years(average age:59.6±8.8 years).All the patients underwent debridement,exchanged polyethylene liner to a vancomycin cement matrixand vacuum sealing drainage(VSD)continuous irrigation with saline for one week per cycle.After infection controlled,anew liner withsamesize was replaced and the surgical incision was closed.Vancomycin was diluted and injected into the articular cavity after operation,and white blood cells,procalcitonin,erythrocyte sedimentation rate and C-reactive protein were checked.Independent sample t test was used to compare the visual analogue scale(VAS)and the Hospital for Special Surgery knee score(HSS)before surgery and three months after surgery to assess the improvement of symptoms and functional recovery.Results After three to four weeks of treatment,all patients were healed satisfactorily.The indexes of leukocyte,procalcitonin,erythrocyte sedimentation rate and C-reactive protein gradually returned to normal.All the patients were followed up for(30.1±17.8)months on average.None of the patients had recurrent infection or new infection.Compared with the scores before the treatment[VAS(5.5±1.4),HSS(43.0±16.2)],postoperative VAS(1.1±1.0)and HSS scores(87.3±5.4)at three months were significantly improved(t=8.713,-8.970,both P<0.05).Conclusions Debridement and implant retention with antibiotic bone cement spacer and vacuum sealing drainage can effectively control infection and preserve good joint function in the treatment of periprosthetic infection after total knee arthroplasty.