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[人工关节周围感染的翻修策略]

[Revision strategy for periprosthetic infection].

作者信息

Lehner B, Witte D, Suda A J, Weiss S

机构信息

Abteilung Orthopädische Onkologie und Septische Orthopädische Chirurgie, Stiftung Orthopädische Universitätsklinik, Schlierbacher Landstrasse 200a, 69118 Heidelberg, Deutschland.

出版信息

Orthopade. 2009 Aug;38(8):681-8. doi: 10.1007/s00132-009-1434-6.

Abstract

Periprosthetic infection remains a major complication in arthroplasty; increasing numbers of primary and revision arthroplasties are being followed by increasing numbers of periprosthetic infections. In cases of possible infection, the surgeon must have a treatment concept that can be individually adjusted. Diagnosis is a challenge and should include a variety of investigations. In early and secondary infections, component retention can be successful. Surgical debridement is the key to success. All late and chronic infections should be treated by explantation of all components because of infection with biofilm-producing microbes. The individual patient's situation and the surgeon's experience should determine whether to choose direct single-stage or two-stage revision. New diagnostic and therapeutic procedures can improve outcomes but cannot replace the need for prophylactic efforts.

摘要

假体周围感染仍然是关节置换术中的主要并发症;随着初次和翻修关节置换术数量的增加,假体周围感染的数量也在增加。在可能发生感染的情况下,外科医生必须有一个可以个体化调整的治疗方案。诊断是一项挑战,应包括各种检查。在早期和中期感染中,保留假体组件可能会成功。手术清创是成功的关键。由于存在产生生物膜的微生物感染,所有晚期和慢性感染都应通过取出所有组件进行治疗。应根据患者的个体情况和外科医生的经验来决定是选择直接一期翻修还是二期翻修。新的诊断和治疗方法可以改善治疗效果,但不能取代预防措施的必要性。

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