Rao Nalini, Crossett Lawrence S, Sinha Raj K, Le Frock Jack L
Division of Infectious Disease, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15232, USA.
Clin Orthop Relat Res. 2003 Sep(414):55-60. doi: 10.1097/01.blo.0000087321.60612.cf.
Optimal treatment for a chronic infected prosthesis is the removal of infected and necrotic tissue and all the components of the prosthesis with staged revision in conjunction with systemic antibiotics. If this is not possible because of the poor general condition of the patient, because of unacceptable functional results secondary to removal of the prosthesis, or because the patient refuses surgery in an attempt to salvage the infected prosthesis, a reasonable alternative is long-term oral suppressive antibiotic therapy for maintenance of a functioning prosthesis. Prompt recognition with rapid debridement and initiation of antibiotic therapy seems crucial. Our study confirms a favorable outcome of maintenance of functioning prostheses in 86.2% of patients after a mean followup of 5 years. All patients had initial debridement with 4 to 6 weeks of systemic antibiotic therapy. Advanced age did not seem to predict poor outcome. Joint location, duration of symptoms, and the time of onset of infection did not predict success or failure. The overall success rate for Staphylococcus aureus prosthetic joint infection was 69% after a mean followup of 5 years. The ideal regimen and optimal duration of oral suppressive therapy for a favorable outcome is not well-established and needs additional data with prospective multicenter studies.
慢性感染性假体的最佳治疗方法是清除感染和坏死组织以及假体的所有组件，并结合全身使用抗生素进行分期翻修。如果由于患者的一般状况较差、因移除假体导致不可接受的功能结果，或者患者拒绝手术以挽救感染的假体而无法做到这一点，那么一种合理的替代方法是长期口服抑制性抗生素治疗以维持假体的功能。迅速识别并进行快速清创和开始抗生素治疗似乎至关重要。我们的研究证实，平均随访5年后，86.2%的患者维持了假体的功能，结果良好。所有患者均接受了初始清创并进行了4至6周的全身抗生素治疗。高龄似乎并不能预示不良结果。关节部位、症状持续时间和感染发作时间并不能预测治疗的成功或失败。金黄色葡萄球菌假体关节感染患者平均随访5年后的总体成功率为69%。对于良好结果而言，理想的口服抑制性治疗方案和最佳持续时间尚未明确确立，需要前瞻性多中心研究提供更多数据。
