灌洗清创术联合保留假体治疗急性假体周围感染。
Irrigation and débridement and prosthesis retention for treating acute periprosthetic infections.
机构信息
Department of Orthopaedic Surgery, University of Pennsylvania Health System, Penn-Presbyterian Medical Center, 1 Cupp Pavilion, 39th and Market Streets, Philadelphia, PA 19104, USA.
出版信息
Clin Orthop Relat Res. 2010 Aug;468(8):2024-8. doi: 10.1007/s11999-010-1291-y.
BACKGROUND
Infections following hip and knee replacements can compromise the function and durability of arthroplasty. When these infections occur during the immediate postoperative period, irrigation and débridement can be attempted to salvage the implant. Prior studies have reported varying results likely due to lack of consistent inclusion criteria, variations in surgical technique, and lack of uniform treatment protocols.
QUESTIONS/PURPOSES: To supplement this literature we determined the rate at which irrigation and débridement and prosthesis retention would control acute periprosthetic infections.
METHODS
We retrospectively reviewed the medical records of 18 patients with acute periprosthetic infections occurring within 28 days after 13 THAs and 5 TKAs. The mean time to reoperation was 19 days (range, 6-28 days) after arthroplasty. Superficial débridements were performed in five cases, and a polyethylene or ball head exchange was performed in the remaining 13 cases when fascial defects were encountered at the time of surgery.
RESULTS
We salvaged the prosthesis in four of five patients with superficial irrigation and débridement group and eight of 13 with deep infections. Intraoperative cultures were positive in 83% of cases (n = 15). Five patients (one superficial and four deep) eventually underwent resection arthroplasty. Three patients underwent repeat irrigation and débridement, and one of these three ultimately had resection arthroplasty. Polymicrobial infections were detected in four cases, all failures. The average time to resection was 62 days (range, 12-134 days).
CONCLUSIONS
Consistent with the literature, success of prosthesis salvage for periprosthetic infections occurring within 28 days after arthroplasty depends on the location, extent, and microbiology of the infection.
LEVEL OF EVIDENCE
Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence.
背景
髋关节和膝关节置换术后的感染会影响关节置换的功能和耐用性。如果这些感染发生在术后的早期，可以尝试冲洗和清创来挽救植入物。先前的研究报告结果存在差异，可能是由于缺乏一致的纳入标准、手术技术的差异以及缺乏统一的治疗方案。
问题/目的：为了补充这方面的文献，我们确定了冲洗和清创以及保留假体是否可以控制急性假体周围感染的发生率。
方法
我们回顾性地分析了 18 例在 13 例髋关节置换术和 5 例膝关节置换术后 28 天内发生急性假体周围感染的患者的病历。再次手术的平均时间为关节置换后 19 天（范围为 6-28 天）。在 5 例病例中进行了浅表清创术，在其余 13 例病例中，如果术中遇到筋膜缺损，则进行聚乙烯或球头置换。
结果
在接受浅表冲洗和清创术的 5 例患者中有 4 例保留了假体，在深部感染的 13 例患者中有 8 例保留了假体。术中培养阳性率为 83%（n=15）。5 例患者（1 例浅表，4 例深部）最终行关节切除成形术。3 例患者行再次冲洗和清创术，其中 1 例最终行关节切除成形术。4 例（均为失败病例）检测到混合感染。关节切除的平均时间为 62 天（范围为 12-134 天）。
结论
与文献一致，对于关节置换术后 28 天内发生的假体周围感染，假体保留的成功率取决于感染的位置、范围和微生物学。
证据等级
IV 级，病例系列研究。有关证据等级的完整描述，请参见作者指南。
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