Zhang Alan L, Feeley Brian T, Schwartz Brian S, Chung Teddy T, Ma C Benjamin
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
J Shoulder Elbow Surg. 2015 Jan;24(1):e15-20. doi: 10.1016/j.jse.2014.04.007. Epub 2014 Jun 25.
Despite the gold standard treatment of 2-stage exchange arthroplasty, reinfection after periprosthetic shoulder infections and periarticular osteomyelitis can be as high as 37%. This study describes a protocol to detect persistent deep shoulder infection before revision arthroplasty.
Patients who presented with periprosthetic shoulder infections and osteomyelitis after previous surgery were treated with a standardized protocol of irrigation and debridement (I&D), removal of implants, antibiotic cement spacer placement, and pathogen-directed antibiotic therapy for 6 weeks. After completion of antibiotics and resolution of clinical symptoms, specimens were obtained from an open biopsy performed in the operating room, followed by revision arthroplasty at a later date if final cultures were without evidence of infection. If evidence of infection persisted, then another course of I&D and antibiotic treatment was performed. American Shoulder and Elbow Surgeon scores were used to evaluate clinical outcomes.
Eighteen patients were included between 2005 and 2012. The most common pathogens isolated were Propionibacterium acnes (44%), Staphylococcus epidermidis (39%), and S aureus (22%). Four patients (22%) had evidence of persistent infection on specimens from open biopsy and required subsequent rounds of I&D before replantation. The infecting pathogen in 75% of patients with persistent infection was P acnes, and 38% of patients with P acnes infection had recurrence. Mean follow-up of 24 months showed no signs of recurrent infection in any patient and an average American Shoulder and Elbow Surgeon score of 71.
Despite prior staged treatment for deep postoperative shoulder infections, specimens obtained from open biopsy before replantation detected a persistent infection rate of 22% in all patients and 38% in patients with P acnes infection, which may indicate a role for this procedure in the prevention of recurrent infections.
尽管两阶段关节置换术是金标准治疗方法，但人工肩关节周围感染和关节周围骨髓炎后的再感染率可能高达37%。本研究描述了一种在翻修关节成形术前检测持续性深部肩部感染的方案。
既往手术后继发人工肩关节周围感染和骨髓炎的患者接受标准化的冲洗清创术（I&D）、植入物取出、抗生素骨水泥间隔物置入以及针对病原体的抗生素治疗6周。抗生素治疗结束且临床症状消退后，从手术室进行的开放活检中获取标本，如果最终培养结果无感染证据，则在之后进行翻修关节成形术。如果仍有感染证据，则进行另一疗程的冲洗清创术和抗生素治疗。采用美国肩肘外科医生评分来评估临床结果。
2005年至2012年纳入了18例患者。分离出的最常见病原体为痤疮丙酸杆菌（44%）、表皮葡萄球菌（39%）和金黄色葡萄球菌（22%）。4例患者（22%）开放活检标本有持续性感染证据，在重新植入前需要后续多轮冲洗清创术。75%持续性感染患者的感染病原体为痤疮丙酸杆菌，38%的痤疮丙酸杆菌感染患者出现复发。平均随访24个月，所有患者均无复发性感染迹象，美国肩肘外科医生平均评分为71分。
尽管先前对深部术后肩部感染进行了分期治疗，但在重新植入前从开放活检中获取的标本显示，所有患者的持续性感染率为22%，痤疮丙酸杆菌感染患者的持续性感染率为38%，这可能表明该程序在预防复发性感染中具有一定作用。
