保留假体清创治疗急性假体周围感染

Debridement, antibiotics, irrigation and retention for acute periprosthetic joint infection

[目的]探讨保留假体清创治疗急性假体周围感染(PJI)的临床效果与炎性指标的早期变化。[方法] 2010年1月~2017年8月,对28例髋/膝关节置换术后急性PJI患者采用保留假体清创联合抗生素治疗,设为感染组。随机选取同期初次髋/膝关节置换患者40例为非感染组。比较两组患者围手术期、随访与实验室检验结果。[结果]两组患者均顺利手术,无严重并发症。膝关节PJI患者中3例出现切口远端裂开,经VSD覆盖患肢制动后瘢痕愈合。两组患者均获得2年以上随访,感染组28例中,23例治愈(82.14%),其中,髋关节PJI治愈率75.00%(9/12),膝关节PJI治愈率87.50%(14/16)。非感染组40例患者随访过程中均未发生感染。实验室检查方面,两组ESR和CRP术后3d上升至峰值,而IL-6于术后1 d即上升至峰值,而后各指标持续下降,14 d接近正常水平上限。不同时间点,感染组ESR、IL-6水平均显著高于非感染组(P<0.05)。感染组的CRP术前、术后1、3 d两组差异有统计学意义(P<0.05),但术后7、14 d两组间差异无统计学意义(P>0.05)。[结论]保留假体清创联合抗生素应用可有效治疗PJI,显著降低IL-6、ESR及CRP水平,其中IL-6变化较为敏感。

[Objective] To explore the clinical outcomes and early variation of inflammatory makers of debridement, antibiotics, irrigation and retention(DAIR) for acute periprosthetic joint infections. [Methods] From January 2010 to August 2017, 28 patients who underwent DAIR treatment for acute PJI secondary to hip or knee arthroplasty were termed as the infection group, while 40 patients who underwent primary major joint arthroplasty during the same period were randomly selected as the non-infection group. The perioperative, followup and laboratory test documents were compared between the two groups. [Results] The patients in both groups had operation performed smoothly without serious complications. Of them, 3 patients with knee PJI had distal incision rupture, which healed after vacuum sealing drainage. All the patients were followed up for more than 2 years. Among the 28 patients in the infection group, 23 patients(82.14%) got cured clinically, with recovery rates of 75.00%(9/12) in the hip PJI and 87.50%(14/16) in the knee PJI. By contrast, all the 40 patients in the non-infection group had no infection happened during the follow-up period. With regard to laboratory tests, the ESR and CRP rose to peak value at 3 days after operation, while the IL-6 increased to the peak at 1 day postoperatively, subsequently all the 3 parameters declined continuously close to the upper limit of the normal values at 14 days postoperatively in both groups(P<0.05). At each corresponding time point, the infection group had significantly higher ESR and IL-6 than the non-infection group(P<0.05). Additionally, the infection group had higher CRP than the non-infection group, which was statistically significant before operation, at 1 and 3 days postoperatively(P<0.05), whereas became not statistically significant at 7 and 14 days after operation(P>0.05). [Conclusion] The DAIR is effective treatment for acute PJI secondary to hip or knee arthroplasty with remarkable decreases IL-6, ESR and CRP, of which the IL-6 might be the most sensitive parameter.