Mihalko William M, Manaswi Abhijit, Cui Quanjun, Parvizi Javad, Schmalzried Thomas P, Saleh Khaled J
Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA.
Instr Course Lect. 2008;57:327-39.
A diagnosis of infection in the painful primary total knee replacement is not always a straightforward endeavor. No single, fail-proof diagnostic study for infection exists. Often multiple diagnostic studies that include imaging, blood work, and joint aspiration as well as history and physical examination need to be considered. Infection may not always be determined before surgery, in which case intraoperative frozen sections can help to confirm infection or refute a negative workup. Treatment options vary, depending on the timing in the infection process and the source of the infection and may consist of simpler treatment courses, such as irrigation, débridement, and polyethylene exchange, to more complex treatment courses, such as two-stage revision with an antibiotic spacer to fusion or amputation. The orthopaedic surgeon uses an essential armamentarium of diagnostic and treatment options to determine the presence of infection and tailor the individual treatment of each patient.
诊断疼痛的初次全膝关节置换术中的感染并非总是一件简单的事情。不存在单一的、万无一失的感染诊断研究。通常需要综合考虑多项诊断研究，包括影像学检查、血液检查、关节穿刺以及病史和体格检查。感染在手术前不一定总能被确定，在这种情况下，术中冰冻切片有助于确诊感染或推翻阴性检查结果。治疗方案因感染过程的阶段和感染源而异，可能包括较简单的治疗过程，如冲洗、清创和聚乙烯置换，也可能包括更复杂的治疗过程，如使用抗生素间隔物的两阶段翻修术，直至融合或截肢。骨科医生运用一系列基本的诊断和治疗手段来确定感染的存在，并为每位患者量身定制个体化治疗方案。
