• 中南大學湘雅醫(yī)院骨科（長沙，410008）;

目的 探討應用抗生素骨水泥間隔體二期翻修治療人工全膝關節(jié)置換術后遲發(fā)感染的臨床療效。 方法2007年1月－2009年12月，收治23例（23膝）人工全膝關節(jié)置換術后遲發(fā)感染患者。男15例，女8例；年齡43～75歲，平均65.2歲。置換術后至出現(xiàn)感染時間為13～52個月，平均17.3個月；發(fā)生感染至入院翻修時間為15 d～7個月，平均2.1個月。一期清創(chuàng)、取出假體，植入含慶大霉素抗生素骨水泥間隔體；8～10周感染控制后二期植入假體。分別采用美國特種外科醫(yī)院（HSS）評分及膝關節(jié)學會評分系統(tǒng)（KSS）評價翻修前后患膝功能，并統(tǒng)計總體感染控制率。 結果術后患者切口均Ⅰ期愈合。2例二期翻修術后發(fā)生再感染，余21例感染控制，總體感染控制率91.3%?；颊呔@隨訪，隨訪時間2～5年，平均3.6年。HSS評分由術前（60.6 ± 9.8）分提高至末次隨訪時（82.3 ± 7.4）分，KSS評分由術前（110.7 ± 9.6） 分提高至末次隨訪時（134.0 ± 10.5）分，手術前后比較差異均有統(tǒng)計學意義（P  lt; 0.01）。X線片復查示假體位置良好，無松動、斷裂、假體周圍透亮影等異常表現(xiàn)。 結論應用抗生素骨水泥間隔體二期翻修能有效控制人工全膝關節(jié)置換術后遲發(fā)感染，并能較好恢復患膝功能。

引用本文： 蔡碰德,胡懿郃,謝杰,汪龍. 應用抗生素骨水泥間隔體二期翻修治療人工全膝關節(jié)置換術后遲發(fā)感染. 中國修復重建外科雜志, 2012, 26(10): 1169-1173. doi: 復制

1. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
2. Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
3. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
4. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
5. Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
6. Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
7. Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
8. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
9. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
10. 史占軍, 肖軍, 李朋. 人工關節(jié)置換術后假體周圍感染的診斷. 中華骨科雜志, 2010, 30(6): 626-629.
11. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
12. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
13. 曹力, 阿斯哈爾江, 張曉崗, 等. 一期翻修術治療全膝關節(jié)置換術后感染. 中華骨科雜志, 2011, 31(2): 131-136.
14. Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
15. Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
16. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
17. Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
18. Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
19. 蔣垚, 沈灝, 張先龍, 等. 帶抗生素可活動關節(jié)骨水泥間隔在全膝關節(jié)置換術后感染中的應用. 中華骨科雜志, 2006, 26(12): 827-830.
20. Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
21. Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
22. MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
23. Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
24. Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
25. Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
26. Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
27. Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
28. Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
29. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
30. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
31. Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
32. Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.
  1. 1. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
  2. 2. Salgado CD, Dash S, Cantey JR, et al. Higher risk of failure of methicillin-resistant Staphylococcus aureus prosthetic joint infections. Clin Orthop Relat Res, 2007, 461: 48-53.
  3. 3. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
  4. 4. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
  5. 5. Ong KL, Mowat FS, Chan N, et al. Economic burden of revision hip and knee arthroplasty in Medicare enrollees. Clin Orthop Relat Res, 2006, (446): 22-28.
  6. 6. Oduwole KO, Molony DC, Walls RJ, et al. Increasing financial burden of revision total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc, 2010, 18(7): 945-948.
  7. 7. Ghanem E, Parvizi J, Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg (Am), 2008, 90(8): 1637-1643.
  8. 8. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
  9. 9. Mortazavi SM, Molligan J, Austin MS, et al. Failure following revision total knee arthroplasty: infection is the major cause. Int Orthop, 2011, 35(8): 1157-1164.
  10. 10. 史占軍, 肖軍, 李朋. 人工關節(jié)置換術后假體周圍感染的診斷. 中華骨科雜志, 2010, 30(6): 626-629.
  11. 11. Insall JN, Ranawat CS, Aglietti P, et al. A comparison of four models of total knee-replacement prostheses. J Bone Joint Surg (Am), 1976, 58(6): 754-765.
  12. 12. Insall JN, Dorr LD, Scott RD, et al. Rationale of the Knee Society clinical rating system. Clin Orthop Relat Res, 1989, (248): 13-14.
  13. 13. 曹力, 阿斯哈爾江, 張曉崗, 等. 一期翻修術治療全膝關節(jié)置換術后感染. 中華骨科雜志, 2011, 31(2): 131-136.
  14. 14. Cordero-Ampuero J, Esteban J, García-Cimbrelo E, et al. Low relapse with oral antibiotics and two-stage exchange for late arthroplasty infections in 40 patients after 2-9 years. Acta Orthop, 2007, 78(4): 511-519.
  15. 15. Hsu CS, Hsu CC, Wang JW, et al. Two-stage revision of infected total knee arthroplasty using an antibiotic-impregnated static cement-spacer. Chang Gung Med J, 2008, 31(6): 583-591.
  16. 16. Zywiel MG, Johnson AJ, Stroh DA, et al. Prophylactic oral antibiotics reduce reinfection rates following two-stage revision total knee arthroplasty. Int Orthop, 2011, 35(1): 37-42.
  17. 17. Chiang ER, Su YP, Chen TH, et al. Comparison of articulating and static spacers regarding infection with resistant organisms in total knee arthroplasty. Acta Orthop, 2011, 82(4): 460-464.
  18. 18. Gooding CR, Masri BA, Duncan CP, et al. Durable infection control and function with the PROSTALAC spacer in two-stage revision for infected knee arthroplasty. Clin Orthop Relat Res, 2011, 469(4): 985-993.
  19. 19. 蔣垚, 沈灝, 張先龍, 等. 帶抗生素可活動關節(jié)骨水泥間隔在全膝關節(jié)置換術后感染中的應用. 中華骨科雜志, 2006, 26(12): 827-830.
  20. 20. Jiranek WA, Hanssen AD, Greenwald AS. Antibiotic-loaded bone cement for infection prophylaxis in total joint replacement. J Bone Joint Surg (Am), 2006, 88(11): 2487-2500.
  21. 21. Hofmann AA, Goldberg T, Tanner AM, et al. Treatment of infected total knee arthroplasty using an articulating spacer: 2- to 12-year experience. Clin Orthop Relat Res, 2005, (430): 125-131.
  22. 22. MacAvoy MC, Ries MD. The ball and socket articulating spacer for infected total knee arthroplasty. J Arthroplasty, 2005, 20(6): 757-762.
  23. 23. Ha CW. A technique for intraoperative construction of antibiotic spacers. Clin Orthop Relat Res, 2006, 445: 204-209.
  24. 24. Villanueva-Martínez M, Ríos-Luna A, Pereiro J, et al. Hand-made articulating spacers in two-stage revision for infected total knee arthroplasty: good outcome in 30 patients. Acta Orthop, 2008, 79(5): 674-682.
  25. 25. Garg P, Ranjan R, Bandyopadhyay U, et al. Antibiotic-impregnated articulating cement spacer for infected total knee arthroplasty. Indian J Orthop, 2011, 45(6): 535-540.
  26. 26. Ellenrieder M, Lenz R, Haenle M, et al. Two-stage revision of implant-associated infections after total hip and knee arthroplasty. GMS Krankenhhyg Interdiszip, 2011, 6(1): 1-8.
  27. 27. Laudermilch DJ, Fedorka CJ, Heyl A, et al. Outcomes of revision total knee arthroplasty after methicillin-resistant Staphylococcus aureus infection. Clin Orthop Relat Res, 2010, 468(8): 2067-2073.
  28. 28. Parvizi J, Azzam K, Ghanem E, et al. Periprosthetic infection due to resistant staphylococci: serious problems on the horizon. Clin Orthop Relat Res, 2009, 467(7): 1732-1739.
  29. 29. Leung F, Richards CJ, Garbuz DS, et al. Two-stage total hip arthroplasty: how often does it control methicillin-resistant infection? Clin Orthop Relat Res, 2011, 469(4): 1009-1015.
  30. 30. Meneghini RM, Lewallen DG, Hanssen AD. Use of porous tantalum metaphyseal cones for severe tibial bone loss during revision total knee replacement. J Bone Joint Surg (Am), 2008, 90(1): 78-84.
  31. 31. Howard JL, Kudera J, Lewallen DG, et al. Early results of the use of tantalum femoral cones for revision total knee arthroplasty. J Bone Joint Surg (Am), 2011, 93(5): 478-484.
  32. 32. Lachiewicz PF, Bolognesi MP, Henderson RA, et al. Can tantalum cones provide fixation in complex revision knee arthroplasty? Clin Orthop Relat Res, 2012, 470(1): 199-204.