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全膝关节置换术后预防假体周围关节感染及降低患者再次入院风险的策略。

Strategies to Prevent Periprosthetic Joint Infection After Total Knee Arthroplasty and Lessen the Risk of Readmission for the Patient.

作者信息

Iorio Richard, Osmani Feroz A

机构信息

From the New York University Langone Medical Center, New York, New York.

出版信息

J Am Acad Orthop Surg. 2017 Feb;25 Suppl 1:S13-S16. doi: 10.5435/JAAOS-D-16-00635.

Abstract

There is yet to be a standardized total knee arthroplasty (TKA) surgical protocol that has been studied to a sufficient degree to offer evidence-based practices regarding infection and readmission prevention. Although high-level evidence is often sought to provide guidance concerning protocol- and process-level decisions, the literature is often confusing and nondefinitive in its conclusions and recommendations regarding periprosthetic joint infection and readmission prevention. Areas of study that require further investigation include the following: the role of patient optimization and preoperative mitigation of risk; perioperative antibiotics; operating room environment; blood management; operative techniques, implants, and infection prevention measures; wound care management; and post acute care. Patient-associated modifiable risk must be optimized to decrease poly joint infection rates after TKA. Protocol measures for TKA need to be standardized, and evidence-based practice measures need to be validated.

摘要

目前尚未有一个经过充分研究的标准化全膝关节置换术(TKA)手术方案,能够提供关于预防感染和再入院的循证实践。尽管人们常常寻求高级别证据来指导方案和流程层面的决策,但文献在关于假体周围关节感染和再入院预防的结论及建议方面往往令人困惑且不明确。需要进一步研究的领域包括:患者优化及术前风险缓解的作用;围手术期抗生素;手术室环境;血液管理;手术技术、植入物及感染预防措施;伤口护理管理;以及急性后期护理。必须优化与患者相关的可改变风险,以降低TKA术后多关节感染率。TKA的方案措施需要标准化,循证实践措施需要得到验证。

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