感染性全膝关节置换术后能否推荐使用假体保留治疗？
Can implant retention be recommended for treatment of infected TKA?
机构信息
Harris Orthopedic Laboratory, Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, GRJ-1126, Boston, MA 02114, USA.
出版信息
Clin Orthop Relat Res. 2011 Apr;469(4):961-9. doi: 10.1007/s11999-010-1679-8.
BACKGROUND
Retention treatment is reportedly associated with lower infection control rates than two-stage revision. However, the studies on which this presumption are based depend on comparisons of historical rather than concurrent controls.
QUESTIONS/PURPOSES: We (1) asked whether the infection control rates, number of additional procedures, length of hospital stay, and treatment duration differed between implant retention and two-stage revision treatment; and (2) identified risk factors that can contribute to failure of infection control.
METHODS
We reviewed the records of 60 patients treated for 64 infected TKA from 2002 to 2007. Twenty-eight patients (32 knees) underwent débridement with retention of component, and 32 patients (32 knees) were treated with component removal and two-stage revision surgery. We determined patients' demographics, type of infection, causative organisms, and outcome of treatment. Mean followup was 36 months (range, 12-84 months).
RESULTS
Infection control rate was 31% in retention and 59% in the removal group after initial surgical treatment, and 81% and 91% at latest followup, respectively. Treatment duration was shorter in the retention group and there was no difference in number of additional surgeries and length of hospital stay. Type of treatment (retention versus removal) was the only factor associated with infection control; subgroup analysis in the retention group showed Staphylococcus aureus infection and polyethylene nonexchange as contributing factors for failure of infection control.
CONCLUSIONS
Although initial infection control rate was substantially lower in the retention group than the removal group, final results were comparable at latest followup. We believe retention treatment can be selectively considered for non-S. aureus infection, and when applied in selected patients, polyethylene exchange should be performed.
LEVEL OF EVIDENCE
Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
据报道，与两阶段翻修相比，保留治疗的感染控制率较低。然而，这一假设所依据的研究依赖于对历史而非同期对照的比较。
问题/目的：我们（1）询问保留治疗和两阶段翻修治疗之间在感染控制率、附加手术数量、住院时间和治疗持续时间方面是否存在差异；（2）确定有助于感染控制失败的风险因素。
方法
我们回顾了 2002 年至 2007 年期间治疗 64 例感染性 TKA 的 60 例患者的记录。28 例患者（32 个膝关节）行清创术保留假体，32 例患者（32 个膝关节）行假体取出和两阶段翻修手术。我们确定了患者的人口统计学、感染类型、病原体和治疗结果。平均随访时间为 36 个月（范围 12-84 个月）。
结果
初次手术治疗后，保留组的感染控制率为 31%，而去除组为 59%；最终随访时，分别为 81%和 91%。保留组的治疗持续时间较短，附加手术数量和住院时间无差异。治疗方式（保留与去除）是与感染控制相关的唯一因素；保留组的亚组分析显示，金黄色葡萄球菌感染和未更换聚乙烯是感染控制失败的因素。
结论
尽管保留组的初始感染控制率明显低于去除组，但在最终随访时结果相当。我们认为保留治疗可选择性用于非金黄色葡萄球菌感染，并且在选择患者时应进行聚乙烯置换。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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