保留假体清创抗生素硫酸钙治疗膝假体周围感染△

Debridement, antibiotics, and implant retention combined with antibiotic-loaded calcium sulfate implantation for periproshetic joint infection after total knee arthroplasty

摘要:

[目的]评价保留假体清创联合硫酸钙抗生素对膝关节置换（total knee arthroplasty, TKA）术后早期假体周围关节感染（periprosthetic joint infection, PJI）的疗效。[方法]2022 年 1 月—2024 年 7 月本科采用保留假体清创联合抗生素硫酸钙治疗收治的 20 例 TKA 术后早期 PJI。评估患者的临床和影像资料。[结果]所有患者均顺利完成手术，术中、术后无严重并发症发生，患者出院时翻修手术切口均愈合良好。20 例患者平均随访（15.4±7.7）个月，末次随访时 18 例治愈，治愈率 90%。2 例术后局部窦道形成，确诊为 PJI 复发，分别于保留假体清创术后 22 d 和 40 d 行假体取出骨水泥占位器置入，二期翻修后感染均控制。 与术前相比，末次随访时 VAS 评分 [(6.9±1.2), (2.3±1.7), P＜0.001] 显著降低，HSS 评分[(48.6±7.9), (79.6±6.3), P＜0.001]，膝伸屈 ROM [(86.0±15.4), (104.8±10.3), P＜0.001] 显著增加。辅助检查方面，20 例患者中，细菌培养阳性 11 例，占 55.0%，其中金葡菌 4 例。与术前相比，末次随访时 ESR [(51.7±28.8) mm/h, (27.8±17.9) mm/h, P 0.01]、CRP [(69.8±64.6) mg/L, ( 21.4±17.5) mg/L, P＜0.01] 显著下降。末次随访时 1 例出现假体周边透亮带。[结论]保留假体清创抗生素硫酸钙可有效治疗膝关节置换术后早期感染，恢复关节功能。

Abstract:

[Objective] To evaluate the clinical efficacy of debridement, antibiotics, and implant retention (DAIR) combined with antibiotic-loaded calcium sulfate implantation for periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). [Methods] From January 2022 to July 2024, a total of 20 patients with early PJI after TKA were treated by debridement, antibiotics, and implant retention (DAIR) combined with antibiotic-loaded calcium sulfate implantation. The clinical and imaging data were evaluated. [Results] All patients had the operation performed successfully with no serious complications, and had the incisions of revision surgery healed well when the patients were discharged. At the latest follow-up lasted for (15.4±7.7) months in a mean, 18 patients were cured, accounted for 90%. However, the remaining 2 patients with postoperative local sinus formation were diagnosed as PJI recurrence, underwent prostheses removed and bone cement spacer placed 22 days and 40 days after DAIR, respectively, had the infection controlled after the second stage of revision. Compared with those preoperatively, the VAS score significantly reduced [(6.9±1.2), (2.3±1.7), P 0.001], while HSS score [(48.6±7.9), (79.6±6.3), P＜0.001] and knee flexion-extension ROM [(86.0±15.4), (104.8±10.3), P＜0.001] was significantly increased at the final interview. In terms of auxiliary examination, 11 of the 20 patients were positive for bacterial culture, accounting for 55.0%, including Staphylococcus aureus in 4 cases, as well as Staphylococcus epidermidis, Staphylococcus haemolyticus, Streptococcus agalactis, Klebsiella pneumoniae, Klebsiella acidogenes, candida parapsilosis And Brucella in 1 case for each. Compared with those preoperatively, the ESR [(51.7±28.8) mm/h, (27.8±17.9) mm/h, P 0.01] and CRP [(69.8±64.6) mg/L, (21.4±17.5) mg/L, P 0.01] dropped significantly at the last follow-up. As for imaging, only 1 patient had periprosthetic transparent band. [Conclusion] The antibiotic-loaded calcium sulfate does effectively treat the early infection after TKA and restore the joint function.