两阶段保留清创术治疗急性人工关节周围感染。
A two-stage retention débridement protocol for acute periprosthetic joint infections.
机构信息
Banner Good Samaritan Orthopaedic Residency Program, Phoenix, AZ, USA.
出版信息
Clin Orthop Relat Res. 2010 Aug;468(8):2029-38. doi: 10.1007/s11999-010-1293-9.
BACKGROUND
Due to the historically poor infection control rates with débridement and component retention for acute periprosthetic infections we developed a new approach for treating acute periprosthetic total joint infections: initial débridement with prosthesis retention and placement of antibiotic-impregnated cement beads followed by a second débridement within 7 days, at which time the beads are removed and new modular parts inserted. Intravenous antibiotics were used for 6 weeks followed by oral antibiotics. Depending on the clinical situation, antibiotics are discontinued or in selected patients continued indefinitely.
QUESTIONS/PURPOSES: We determined the ability of this two-stage débridement to control infection.
METHODS
We retrospectively reviewed the charts of 20 patients who underwent this technique; 2 had postoperative and 18 had hematogenous infections. The primary outcome measure was the infection control. The minimum followup was 1 year (mean, 3.5 years; range, 1.2-7.5 years).
RESULTS
Two of the 20 patients had persistent infection. There were no failures in the acute postoperative group (0 of 2) and two of 18 in the acute hematogenous group. Of the 18 patients without evidence of persistent infection, 10 were no longer on antibiotics at the most recent followup and eight were treated with long-term antibiotics due to compromised host status.
CONCLUSIONS
The control of infection in 18 of 20 patients using this technique compares favorably with historical success rates, which range from 24% to 100%. Further research is required to analyze the individual contribution of débridement technique, the use of serial débridements, local depot antibiotics, and combination antibiotic therapy on short-term infection control rates and the long-term persistent control of periprosthetic infection.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of level of evidence.
背景
由于清创术和保留假体治疗急性假体周围感染的感染控制率历来较差，我们开发了一种治疗急性假体周围全关节感染的新方法：初次清创术保留假体和放置抗生素浸渍水泥珠，然后在 7 天内进行第二次清创术，此时取出珠并插入新的模块化部件。静脉内使用抗生素 6 周，然后口服抗生素。根据临床情况，可停用或在选定患者中无限期继续使用抗生素。
问题/目的：我们确定了这种两阶段清创术控制感染的能力。
方法
我们回顾性分析了 20 例接受该技术治疗的患者的病历；2 例为术后感染，18 例为血源性感染。主要结局指标是感染控制。随访时间至少为 1 年（平均 3.5 年；范围，1.2-7.5 年）。
结果
20 例患者中有 2 例持续感染。急性术后组无失败（2 例均无），急性血源性组 18 例中有 2 例失败。在没有持续感染证据的 18 例患者中，10 例在最近的随访中已不再使用抗生素，8 例因宿主状态受损而接受长期抗生素治疗。
结论
使用该技术控制 20 例患者中的 18 例感染的成功率与历史成功率（24%-100%）相比具有优势。需要进一步研究来分析清创术技术、连续清创术、局部储库抗生素和联合抗生素治疗对短期感染控制率和假体周围感染长期持续控制的单独贡献。
证据水平
IV 级，治疗研究。请参阅作者指南以获取完整的证据水平描述。
Zotero 插件