急性膝假体周围感染保留假体治疗8年经验△

Eight- year experience in debridement, antibiotics and implant retention for acute periprosthetic infection of the knee

摘要:

［目的］ 探讨清创保留假体 （debridement, antibiotics and implant retention, DAIR） 联合滴注引流治疗急性膝关节假体周围感染 （periprosthetic joint infection, PJI） 的临床疗效。［方法］ 回顾性分析 2012 年１月—2020 年 6 月本院收治的 21 例 （21 膝）急性 PJI 患者的临床资料。所有患者均采用 DAIR 联合滴注引流治疗，比较手术前后 VAS 评分、膝关节 HSS 评分、膝伸屈活动度 ROM 及实验室检查结果变化情况，评估感染治愈率。［结果］所有患者均顺利完成手术，术中无血管、神经损伤等严重并发症。21 例患者随访（3.62±2.50）年。其中，15 例感染治愈，占 71.43%；6 例感染复发，占 28.57%，后经二期翻修术恢复良好。术后随时间推移，膝关节 HSS 评分、膝伸屈 ROM 较术前显著增加 （P<0.05），而 VAS 评分较术前显著降低 （P<0.05）。 细菌学方面，21 例患者细菌培养阳性结果 14 例，阴性结果 7 例。阳性病例中金黄色葡萄球菌 8 例，包括 MRSA 5 例，表皮葡萄球菌 3 例，铜绿假孢杆菌 1 例；革兰阴性杆菌 2 例。检验方面，术后 ESR、CRP、IL-6 较术前均显著降低 （P<0.05）。影像显示，末次随访 X 线片示假体位置良好，无断裂、松动，未见明显透光影。［结论］DAIR 联合滴注引流在治疗急性 PJI 中能够有效控制感染且保留良好的关节功能。

Abstract:

[Objective] To explore the clinical outcomes of debridement, antibiotics and implant retention (DAIR) combined with irriga- tion drainage for periprosthetic joint infection (PJI) . [Methods] A retrospective study was done on 21 patients (21 knees) who were admit- ted into our hospital for acute PJI from January 2012 to June 2020. All patients were treated with DAIR combined with irrigation and drain- age. The VAS and HSS scores, as well as knee extensor-flexion range of motion (ROM) and laboratory test results were compared among dif- ferent time points, additionally the successful rate of infection control was evaluated. [Results] All patients were successfully operated on without serious complications such as vascular and nerve injury. The 21 patients were followed up for (3.62±2.50) years. Among them, 15 cases got successful infection control, accounted for 71.43% , whereas the remaining 6 patients had infection recurred, accounted for 28.57%, which controlled well after the two-stage revision. The HSS score and ROM increased significantly (P＜0.05) , whereas the VAS score decreased significantly over time postoperatively (P＜0.05) . In terms of bacteriology, 14 patients got positive results, while 7 were of negative among the 21 patients. The positive results involved 8 cases of staphylococcus aureus, including 5 cases of MRSA; 3 cases of Staphylococcus epidermidis; 1 case of pseudomonas aeruginosa and 2 cases of gram-negative bacilli. In terms of blood test, ESR, CRP and IL-6 were significantly decreased after operation compared with those preoperatively (P＜0.05) . The regular radiographic checks revealed that the prosthetic components remained in proper positions without fracture, loosening, and no obvious lightening shadow was seen. [Conclusion] The DAIR combined with irrigation drainage do effectively control infection and preserve good joint function for acute PJI.