人工髋关节和膝关节周围感染清创及植入物保留的适应症和指南
Indications and Guidelines for Debridement and Implant Retention for Periprosthetic Hip and Knee Infection.
作者信息
Zaruta Douglas A, Qiu Bowen, Liu Andrew Y, Ricciardi Benjamin F
机构信息
Department of Orthopedic Surgery, University of Rochester School of Medicine, Highland Hospital, 1000 South Avenue, Rochester, NY, 14620, USA.
出版信息
Curr Rev Musculoskelet Med. 2018 Sep;11(3):347-356. doi: 10.1007/s12178-018-9497-9.
Abstract
PURPOSE OF REVIEW
Prosthetic joint infection is one the most common causes of revision surgery after hip or knee replacement. Debridement and implant retention (DAIR) is one method of treating these infections; however, significant controversy exists. The purpose of our review was to describe current knowledge about indications, intraoperative/postoperative patient management, and outcomes of DAIR.
RECENT FINDINGS
Patient selection affects the success of DAIR. Medical comorbidities, duration of symptoms, and nature of infectious organism all influence outcomes. Intraoperative techniques such as open arthrotomy, extensive debridement, copious irrigation, and exchange of modular parts remain current standards for DAIR. Postoperative administration of antibiotics tailored to operative cultures remains critical. Antibiotic suppression may increase the success of DAIR. DAIR provides reasonable infection eradication between 50 and 80% with improved outcomes in appropriately selected patients. More research is needed on the use of adjuvant therapies intraoperatively and the role of postoperative antibiotic suppression.
摘要
综述目的
人工关节感染是髋关节或膝关节置换术后翻修手术最常见的原因之一。清创及保留植入物（DAIR）是治疗这些感染的一种方法；然而，存在重大争议。我们综述的目的是描述关于DAIR的适应证、术中/术后患者管理及结果的当前知识。
最新发现
患者选择影响DAIR的成功率。内科合并症、症状持续时间及感染病原体的性质均会影响结果。诸如切开关节、广泛清创、大量冲洗及更换组合部件等术中技术仍是DAIR的现行标准。根据手术培养结果定制术后抗生素给药仍然至关重要。抗生素抑制可能会提高DAIR的成功率。DAIR在50%至80%的患者中能合理地根除感染，在适当选择的患者中结果有所改善。关于术中辅助治疗的使用及术后抗生素抑制的作用，还需要更多研究。
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