Beekman P D A, Katusic D, Berghs B M, Karelse A, De Wilde L
Deparment of Orthopaedic Surgery Physical Medicine and Rehabilitation, Ghent University Hospital, B-9000 Ghent, Belgium.
J Bone Joint Surg Br. 2010 Jun;92(6):817-22. doi: 10.1302/0301-620X.92B6.23045.
We retrospectively reviewed 11 consecutive patients with an infected reverse shoulder prosthesis. Patients were assessed clinically and radiologically, and standard laboratory tests were carried out. Peroperative samples showed Propionbacterium acnes in seven, coagulase-negative Staphylococcus in five, methicillin-resistant staphylococcus aureus in one and Escherichia coli in one. Two multibacterial and nine monobacterial infections were seen. Post-operatively, patients were treated with intravenous cefazolin for at least three days and in all antibiotic therapy was given for at least three months. Severe pain (3 of 11) or severe limitation of function (3 of 11) are not necessarily seen. A fistula was present in eight, but function was not affected. All but one patient were considered free of infection after one-stage revision at a median follow-up of 24 months, and without antibiotic treatment for a minimum of six months. One patient had a persistent infection despite a second staged revision, but is now free of infection with a spacer. Complications included posterior dislocation in one, haematoma in one and a clavicular fracture in one. At the most recent follow-up the median post-operative Constant-Murley score was 55, 6% adjusted for age, gender and dominance. A one-stage revision arthroplasty reduces the cost and duration of treatment. It is reliable in eradicating infection and good functional outcomes can be achieved.
我们回顾性研究了连续11例感染性反肩关节假体患者。对患者进行了临床和放射学评估，并进行了标准实验室检查。术中样本显示，7例为痤疮丙酸杆菌感染，5例为凝固酶阴性葡萄球菌感染，1例为耐甲氧西林金黄色葡萄球菌感染，1例为大肠杆菌感染。发现2例混合细菌感染和9例单一细菌感染。术后，患者接受静脉注射头孢唑林治疗至少3天，所有患者均接受了至少3个月的抗生素治疗。不一定会出现严重疼痛（11例中有3例）或严重功能受限（11例中有3例）。8例存在瘘管，但功能未受影响。除1例患者外，所有患者在一期翻修术后中位随访24个月时被认为无感染，且至少6个月未接受抗生素治疗。1例患者尽管进行了二期翻修仍持续感染，但现在使用间隔物后已无感染。并发症包括1例后脱位、1例血肿和1例锁骨骨折。在最近的随访中，术后Constant-Murley评分中位数为55，根据年龄、性别和优势情况调整后为6%。一期翻修关节成形术可降低治疗成本和缩短治疗时间。它在根除感染方面可靠，并且可以取得良好的功能结果。
