• 天津市人民醫(yī)院關(guān)節(jié)外科（天津，300121）;

目的探討人工全膝關(guān)節(jié)置換（total knee arthroplasty，TKA）術(shù)后深部感染的處理方法及療效。 方法2004年1月－2010年1月，收治TKA 術(shù)后深部感染患者32例（32膝）。男13例，女19例；年齡52～79歲，平均64.6歲。TKA手術(shù)距發(fā)生感染時(shí)間為3周～10年。膝關(guān)節(jié)功能采用膝關(guān)節(jié)學(xué)會(huì)評(píng)分系統(tǒng)（KSS）為（104.6 ± 9.1）分，疼痛視覺(jué)模擬評(píng)分（VAS）為（7.8 ± 1.4）分。急性感染3例行關(guān)節(jié)切開(kāi)清創(chuàng)后持續(xù)沖洗；急性血源性播散感染3例于關(guān)節(jié)鏡下清創(chuàng)；慢性感染26例，其中行關(guān)節(jié)切開(kāi)清創(chuàng)后持續(xù)沖洗9例，抗生素骨水泥隔體植入4例，二期翻修12例，抗生素保守治療1例。 結(jié)果急性感染者治療均失敗，急性血源性播散感染者1例治療失敗，慢性感染者7例清創(chuàng)及1例保守治療失敗；均經(jīng)對(duì)癥治療后治愈。32例患者均獲隨訪(fǎng)，隨訪(fǎng)時(shí)間2～8年，平均4.6年。末次隨訪(fǎng)時(shí)KSS評(píng)分為（158.4 ± 8.3）分，VAS評(píng)分為（4.1 ± 0.8）分，與術(shù)前比較差異有統(tǒng)計(jì)學(xué)意義（P  lt; 0.05）。隨訪(fǎng)期間再感染3例，均為二期翻修患者。 結(jié)論 TKA術(shù)后耐甲氧西林金黃色葡萄球菌急性感染切開(kāi)清創(chuàng)成功率低；急性血源性播散感染可試行關(guān)節(jié)鏡下清創(chuàng)；慢性感染二期翻修膝關(guān)節(jié)功能恢復(fù)良好，但遠(yuǎn)期存在再感染風(fēng)險(xiǎn)。

引用本文： 孫振輝,王磊,孫云波,曹建剛,張宇,田孟強(qiáng),劉軍. 人工全膝關(guān)節(jié)置換術(shù)后深部感染的治療. 中國(guó)修復(fù)重建外科雜志, 2012, 26(8): 918-921. doi: 復(fù)制

1. Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
2. Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
3. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
4. Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
5. Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
6. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
7. Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
8. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
9. Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
10. Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
11. Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
12. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
13. Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
14. Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
15. Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
16. 余世明, 張紫機(jī), 盛璞義, 等. 兩種間隔器在膝關(guān)節(jié)置換術(shù)后假體感染的二期翻修術(shù)中應(yīng)用的比較和分析. 中華關(guān)節(jié)外科雜志(電子版), 2010, 4(4): 482-487.
17. Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
18. Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
19. Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.
  1. 1. Moyad TF, Thornhill T, Estok D. Evaluation and management of the infected total hip and knee. Orthopedics, 2008, 31(6): 581-588.
  2. 2. Garvin KL, Cordero GX. Infected total knee arthroplasty: diagnosis and treatment. Instr Course Lect, 2008, 57: 305-315.
  3. 3. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A(Suppl 1): S75-80.
  4. 4. Kubista B, Hartzaler RU, Wood CM, et al. Reinfection after two-stage revision for periprosthetic infection of total knee arthroplasty. Int Orthop, 2012, 36(1): 65-71.
  5. 5. Savarino L, Tigani D, Baldini N, et al. Pre-operative diagnosis of infection in total knee arthroplasty: an algorithm. Knee Surg Sports Traumatol Arthrosc, 2009, 17(6): 667-675.
  6. 6. Berbari E, Mabry T, Tsaras G, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg (Am), 2010, 92(11): 2102-2109.
  7. 7. Matthews PC, Berendt AR, McNally MA, et al. Diagnosis and management of prosthetic joint infection. BMJ, 2009, (338): b1773.
  8. 8. Parvizi J, Zmistowski B, Adeli B. Periprosthetic joint infection: treatment options. Orthopedics, 2010, 33(9): 659.
  9. 9. Hanssen AD. Managing the infected knee: as good as it gets. J Arthroplasty, 2002, 17(4 Suppl 1): 98-101.
  10. 10. Sener N, Asik M, Tözün IR, et al. Infekte total diz artroplastisinde debridmant antibiyotik süpresyonu. Acta Orthop Traumatol Turc, 1998, 32(5): 408-410.
  11. 11. Estes CS, Beauchamp CP, Clarke HD, et al. A two-stage retention débridement protocol for acute periprosthetic joint infections. Clin Orthop Relat Res, 2010, 468(8): 2029-2038.
  12. 12. Bradbury T, Fehring TK, Taunton M, et al. The fate of acute methicillin-resistant Staphylococcus aureus periprosthetic knee infections treated by open debridement and retention of components. J Arthroplasty, 2009, 24(6 Suppl): 101-104.
  13. 13. Ilahi OA, Al-Habbal GA, Bocell JR, et al. Arthroscopic debridement of acute periprosthetic septic arthritis of the knee. Arthroscopy, 2005, 21(3): 303-306.
  14. 14. Wilde AH, Ruth JT. Two-stage reimplantation in infected total knee arthroplasty. Clin Orthop Relat Res, 1988, (236): 23-35.
  15. 15. Macheras GA, Kateros K, Galanakos SP, et al. The long-term results of a two-stage protocol for revision of an infected total knee replacement. J Bone Joint Surg (Br), 2011, 93(11): 1487-1492.
  16. 16. 余世明, 張紫機(jī), 盛璞義, 等. 兩種間隔器在膝關(guān)節(jié)置換術(shù)后假體感染的二期翻修術(shù)中應(yīng)用的比較和分析. 中華關(guān)節(jié)外科雜志(電子版), 2010, 4(4): 482-487.
  17. 17. Lee J, Kang CI, Lee JH, et al. Risk factors for treatment failure in patients with prosthetic joint infections. J Hosp Infect, 2010, 75(4): 273-276.
  18. 18. Ocguder A, Firat A, Tecimel O, et al. Two-stage total infected knee arthroplasty treatment with articulating cement spacer. Arch Orthop Trauma Surg, 2010, 130(6): 719-725.
  19. 19. Neogi DS, Kumar A, Yadav CS, et al. Delayed periprosthetic tuberculosis after total knee replacement: is conservative treatment possible? Acta Orthop Belg, 2009, 75(1): 136-140.