Lehner B, Bernd L
Stiftung Orthopädische Universitätsklinik, Heidelberg.
Zentralbl Chir. 2006 Apr;131 Suppl 1:S160-4. doi: 10.1055/s-2006-921513.
Periprosthetic infection represents a main complication of arthroplasty. In case of an early infection the implant often can be left in place. Whether instillation of antiseptic solution using a reticulated sponge in combination with negative pressure wound therapy (V.A.C.-Instill) can be useful was the aim of our investigation. Up to now the instillation of Lavasept in combination with negative pressure wound therapy could be performed in three patients. In two cases an early infection of a hip prosthesis and one infected knee implant had to be treated. Following surgical debridement V.A.C.-Instill therapy was performed for 4-7 days followed by closure of the wound or a repeated application. Lavasept was used for irrigation. In all three cases retention of the primary implant could be achieved. The follow up now is 8 to 22 weeks. No recurrence of the infection occurred. After salvage of the prosthesis the joint allowed full load bearing and painfree mobilisation. The V.A.C.-Instill system proved to be easy to use. With this system early periprosthetic infection with antiseptic irrigation in combination with negative pressure wound therapy decreasing the bacterial burden, salvage of prosthesis seems to be possible. The therapy is applicable in hip and knee prosthesis. Final conclusions about this therapy however can be done only after a larger series of patients.
假体周围感染是关节置换术的主要并发症。对于早期感染，植入物通常可保留原位。本研究旨在探讨使用网状海绵滴注抗菌溶液联合负压伤口治疗（V.A.C.-Instill）是否有效。到目前为止，已有3例患者接受了Lavasept滴注联合负压伤口治疗。其中2例为髋关节假体早期感染，1例为膝关节植入物感染。手术清创后，进行4 - 7天的V.A.C.-Instill治疗，然后关闭伤口或重复应用。使用Lavasept进行冲洗。所有3例患者均成功保留了初次植入物。目前随访时间为8至22周，感染未复发。假体挽救后，关节可完全负重且无痛活动。V.A.C.-Instill系统使用简便。通过该系统，联合抗菌冲洗和负压伤口治疗可降低细菌负荷，早期假体周围感染似乎有可能挽救假体。该治疗方法适用于髋关节和膝关节假体。然而，只有在更多患者的系列研究之后才能得出关于该治疗的最终结论。
