Pellegrini Antonio, Legnani Claudio, Macchi Vittorio, Meani Enzo
Reconstructive Surgery and Septic Complications Surgery Center, IRCCS Galeazzi Orthopaedic Institute, San Siro Clinical Institute Site, Milan, Italy.
IRCCS Galeazzi Orthopaedic Institute, Milan, Italy.
Arch Orthop Trauma Surg. 2018 May;138(5):605-609. doi: 10.1007/s00402-018-2870-8. Epub 2018 Jan 15.
Management of periprosthetic shoulder infections (PSIs) still remains challenging. We conducted a retrospective case study to assess the outcomes of definitive articulating antibiotic spacer implantation in a cohort of elderly, low-demanding patients. We hypothesized that in patients with low functional demands seeking pain relief with chronic PSIs, treatment with a definitive articulating antibiotic spacer would lead to satisfying results concerning eradication of the infection, improvement of pain, and improving shoulder function.
19 patients underwent definitive articulating antibiotic spacer implantation for the treatment of an infected shoulder arthroplasty. Mean age at surgery was 70.2 years. Patients were assessed pre-operatively with functional assessment including Constant-Murley score, and objective examination comprehending ROM, visual analog scale pain score, and patient subjective satisfaction (excellent, good, satisfied, or unsatisfied) score. Radiographs were taken to examine signs of loosening, and change in implant positioning.
At the most recent follow-up, none of the patients had clinical or radiographic signs suggesting recurrent infection. Most patients reported satisfying subjective and objective outcomes. Follow-up examination showed significant improvement of all variables compared to pre-operative values (p < 0.001). Radiographs did not show progressive radiolucent lines or change in the position of the functional spacer. In one case, glenoid osteolysis was reported, which did not affect the clinical outcome.
In selected elderly patients with low functional demands seeking pain relief with infected shoulder arthroplasty, definitive management with a cement spacer is a viable treatment option that helps in eradicating shoulder infection and brings satisfying subjective and objective outcomes.
Case series, Level IV.
人工肩关节周围感染（PSIs）的管理仍然具有挑战性。我们进行了一项回顾性病例研究，以评估在一组老年、需求较低的患者中植入确定性关节抗生素间隔物的效果。我们假设，对于功能需求较低、寻求缓解慢性PSIs疼痛的患者，采用确定性关节抗生素间隔物治疗将在感染根除、疼痛改善和肩关节功能改善方面取得令人满意的结果。
19例患者接受了确定性关节抗生素间隔物植入术，以治疗感染性肩关节置换术。手术时的平均年龄为70.2岁。术前对患者进行功能评估，包括Constant-Murley评分，并进行客观检查，包括关节活动度（ROM）、视觉模拟疼痛评分以及患者主观满意度（优秀、良好、满意或不满意）评分。拍摄X线片以检查松动迹象和植入物位置的变化。
在最近的随访中，没有患者出现提示反复感染的临床或影像学迹象。大多数患者报告了令人满意的主观和客观结果。随访检查显示，与术前值相比，所有变量均有显著改善（p < 0.001）。X线片未显示进行性透亮线或功能性间隔物位置的变化。有1例报告了肩胛盂骨溶解，但未影响临床结果。
对于功能需求较低、因感染性肩关节置换术寻求疼痛缓解的特定老年患者，使用骨水泥间隔物进行确定性治疗是一种可行的治疗选择，有助于根除肩关节感染，并带来令人满意的主观和客观结果。
病例系列，IV级。
