全膝假体周围感染的清创抗生素假体保留治疗

Debridement, antibiotics and implant retention for periprosthetic joint infection after total knee arthroplasty

摘要:

[目的] 探讨初次全膝置换术后假体周围感染 （periprosthetic joint infection, PJI） 的清创抗生素假体保留 （debride- ment, antibiotics, and implant retention, DAIR）治疗的临床效果。[方法]回顾性分析 2016 年 1 月—2020 年 6 月在本科采用 DAIR 治疗的 33 例初次全膝置换术后感染患者的临床资料，其中术后 3 个月内感染 28 例，术后 4~6 个月内感染 5 例。评价临床及检验结果。[结果] 所有患者均顺利完成手术，手术时间平均 （113.5±12.4） min，术中失血量平均 （43.5±7.4） ml。随访 （44.1± 11.7）个月，28 例手术成功，成功率 84.8%；5 例手术失败，其中初次置换术后 3 个月内感染 2 例，术后 4~6 个月内感染 3 例， 失败率 15.2%。与术前相比，末次随访时，患者疼痛 VAS 评分 [(5.1±1.4), (1.4±0.9), P＜0.001] 显著降低，膝关节 KSS 功能评分 [(43.0±9.9), (81.8±11.3 ), P＜0.001] 、KSS 临床评分 [(37.8±14.9), (84.0±7.0), P＜0.001] 均显著增加。检验方面，15 例（45.5%）细菌培养结果阴性，18 例（54.5%）细菌培养阳性。随时间推移，WBC、CRP、ESR 均显著降低（P＜0.05）。[结论]采用 DAIR 治疗 PJI 可取得较好的早期疗效。相比术后 3 个月内 PJI，术后 4~6 个月内的 PJI，失败率较高。

Abstract:

[Objective] To investigate the clinical outcomes of debridement, antibiotics, and implant retention (DAIR) for periprosthetic joint infection (PJI) after primary total knee arthroplasty (TKA). [Methods] A retrospective study was conducted on 33 patients who received DAIR for PJI in our hospital from January 2016 to June 2020, including 28 patients suffered from PJI within 3 months after TKA, and 5 pa- tients in 4~6 months after surgery. The clinical and laboratory results were evaluated. [Results] All patients had DAIR performed successful- ly with operation time of (113.5±12.4) min, and intraoperative blood loss of (43.5±7.4) ml, and were followed up for (44.1±11.7) months. Of them, 28 cases were successful with the success rate of 84.8%, whereas 5 cases were of surgical failure, including 2 cases infected within 3 months after the initial replacement, 3 cases infected in 4 to 6 months after the operation, with the failure rate of 15.2%. Compared with those before DAIR, the VAS score for pain [(5.1±1.4), (1.4±0.9), P＜0.001] significantly reduced, while the KSS functional score [(43.0±9.9), (81.8± 11.3), P＜0.001] and KSS clinical score [(37.8±14.9), (84.0±7.0), P＜0.001] significantly increased at the latest follow-up. In term of lab test, bacterial culture were negative in 15 cases (45.5%), whereas positive in 18 cases (54.5%). The WBC, CRP and ESR were significantly de- creased over time (P＜0.05). [Conclusion] The DAIR does achieve satisfactory early clinical consequences for PJI. However, its failure rate for PJI in 4 to 6 months after primary TKA is relatively higher than that within 3 months after the surgery.