Pang Hee-Nee, Seah Renyi Benjamin, MacDonald Steven J
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
Knee. 2015 Oct;22(5):440-2. doi: 10.1016/j.knee.2015.06.015. Epub 2015 Jul 26.
We present a case of multifocal infection involving the left total hip replacement and the right total knee replacement of a patient, further complicated by an infected non-union of a periprosthetic fracture of the right knee. This required the unique simultaneous management of both infection eradication and fracture stabilization in the knee.
Both sites were treated with a two-stages procedure, including the novel use of a stemmed articulating spacer for the right knee. This spacer was made combining a retrograde humeral nail, coated with antibiotic-impregnated cement, and a pre-formed articulating cement spacer. The patient was able to weight-bear on this spacer.
The fracture went on to unite, and a second stage was performed with the use of stemmed prosthesis and augments. She remains infection free two years after the second stage operation.
The use of a stemmed articulating knee spacer can facilitate infection eradication and fracture stabilization while preserving some motion and weight-bearing ability in the two-stages management of an infected periprosthetic fracture of the knee.
Level V (Case report).
我们报告一例患者，其左全髋关节置换术和右全膝关节置换术均发生多灶性感染，右膝关节假体周围骨折并发感染性骨不连，这需要同时对膝关节感染进行根除并稳定骨折。
两个部位均采用两阶段手术治疗，包括在右膝关节新颖地使用带柄关节间隔器。该间隔器由逆行肱骨钉与预成型关节骨水泥间隔器组合而成，逆行肱骨钉涂有含抗生素的骨水泥。患者能够依靠这个间隔器负重。
骨折实现愈合，第二阶段使用带柄假体及增强物进行手术。第二阶段手术后两年，患者仍未发生感染。
在膝关节感染性假体周围骨折的两阶段治疗中，使用带柄关节膝关节间隔器有助于根除感染和稳定骨折，同时保留一定的活动和负重能力。
V级（病例报告）。
