Lombardi Adolph V, Karnes Jonathan M, Berend Keith R
Joint Implant Surgeons, Inc, New Albany, Ohio 43054, USA.
J Arthroplasty. 2007 Jun;22(4 Suppl 1):50-5. doi: 10.1016/j.arth.2007.01.025.
Two-stage radical debridement with implant removal, antibiotic therapy, and delayed reimplantation remains the treatment of choice for deep infection in total joint arthroplasty. Studies have shown that articulating vs static spacers better improve functional results, increase patient satisfaction, prevent bone loss, and facilitate reimplantation without increasing risk of infection. Articulating spacers fabricated from cement provide a vehicle for prolonged local delivery of antibiotics. We currently use a mold system for creating antibiotic-laden articulating cement spacers. Disposable femoral and tibial molds are injection-filled with low-viscosity cement vacuum mixed with 3.6 to 4.8 g of tobramycin or gentamicin and 3.0 to 4.0 g of vancomycin per 40-g unit and massaged to fill any voids. After curing, the temporary spacers are removed from the molds, trimmed smooth, and cemented loosely into the joint space.
两阶段根治性清创术，包括取出植入物、抗生素治疗和延迟再植入，仍然是全关节置换术中深部感染的首选治疗方法。研究表明，与静态间隔物相比，活动式间隔物能更好地改善功能结果、提高患者满意度、防止骨质流失，并便于再植入，且不会增加感染风险。由骨水泥制成的活动式间隔物为抗生素的长期局部递送提供了一种载体。我们目前使用一种模具系统来制作含抗生素的活动式骨水泥间隔物。一次性股骨和胫骨模具用低粘度骨水泥进行注射填充，该骨水泥是将每40克单位的骨水泥与3.6至4.8克妥布霉素或庆大霉素以及3.0至4.0克万古霉素进行真空混合，然后进行按摩以填充任何空隙。固化后，将临时间隔物从模具中取出，修剪光滑，并松散地固定在关节间隙中。
