Fink Bernd, Schuster Philipp, Schwenninger Christoph, Frommelt Lars, Oremek Damian
Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany; Department of Orthopaedics, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
Clinic of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic Markgröningen gGmbH, Markgröningen, Germany.
J Arthroplasty. 2017 Apr;32(4):1255-1261. doi: 10.1016/j.arth.2016.10.011. Epub 2016 Oct 20.
Papers concerning the treatment of periprosthetic infections and acute hematogenous infections often concern inhomogeneous treatment concepts or low numbers of patients; this results in inconsistent rates of treatment success.
Thirty-nine patients with early periprosthetic infections and 28 patients with acute hematogenous infections were treated with a homogeneous concept and followed with a mean period of 41.8 (24-132) months in order to investigate the success rate and influencing factors. All patients were treated with open surgical debridement, a revision of all removable components and irrigation with an antiseptic solution (octinedine). All patients received a systemic vancomycin/rifampicin antibiotic therapy until the microorganism causing the infection could be identified; a specific antibiotic therapy then followed until the end of the sixth week.
This unified treatment regimen resulted in an overall success rate of 71.6%, an 82.1% success for early infections and 57.1% for acute hematogenous infections. Variables that influenced the recurrence of an infection were the timespan between revision and first appearance of symptoms (<2 days), the number of previous operations, the American Society of Anesthesiologists classification, and nicotine abuse.
It appears that, in cases of early postoperative infection, a reproducibly high rate of success in retaining an implant can be achieved with this specific therapy regime if surgical intervention can be carried out within 2 days of first symptoms.
关于假体周围感染和急性血源性感染治疗的论文，往往涉及不均匀的治疗概念或患者数量较少的情况；这导致治疗成功率不一致。
39例早期假体周围感染患者和28例急性血源性感染患者采用统一的治疗方案，并平均随访41.8（24 - 132）个月，以研究成功率及影响因素。所有患者均接受开放性手术清创、所有可移除部件的翻修以及用消毒溶液（辛二定）冲洗。所有患者在确定引起感染的微生物之前接受全身万古霉素/利福平抗生素治疗；随后进行针对性抗生素治疗直至第六周结束。
这种统一的治疗方案总体成功率为71.6%，早期感染成功率为82.1%，急性血源性感染成功率为57.1%。影响感染复发的变量包括翻修与首次出现症状之间的时间间隔（<2天）、既往手术次数、美国麻醉医师协会分级以及尼古丁滥用情况。
对于术后早期感染的病例，如果在首次出现症状后2天内进行手术干预，采用这种特定的治疗方案似乎可以实现可重复的高植入物保留成功率。
