两阶段翻修关节成形术治疗人工关节感染
Two-Stage Revision Arthroplasty for the Treatment of Prosthetic Joint Infection.
作者信息
Charette Ryan S, Melnic Christopher M
机构信息
Resident, Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, 6th Floor, Philadelphia, PA, 19104, USA.
Department of Orthopaedic Surgery, Massachusetts General Hospital, Newton Wellesley Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
出版信息
Curr Rev Musculoskelet Med. 2018 Sep;11(3):332-340. doi: 10.1007/s12178-018-9495-y.
Abstract
PURPOSE OF REVIEW
To review the diagnosis and treatment of prosthetic joint infection (PJI) with a focus on two-stage revision arthroplasty. The text will discuss different spacer constructs in total knee and total hip arthroplasty and will present clinical outcome data for these various options.
RECENT FINDINGS
There is no appreciable difference in infection eradication between mobile and static antibiotic spacers. Mobile spacers have shown improved knee range of motion after second-stage re-implantation. Two-stage revision arthroplasty is the gold standard treatment for PJI. The first stage involves removal of all components, cement, and compromised soft tissues with placement of an antibiotic-impregnated spacer. Spacer options include both mobile and static spacers. Mobile spacers offer maintenance of ambulation and joint range of motion between staged procedures and have shown to be as effective in eradicating infection as static spacers.
摘要
综述目的
回顾人工关节感染（PJI）的诊断和治疗，重点关注两阶段翻修关节成形术。本文将讨论全膝关节和全髋关节置换术中不同的间隔物构建，并展示这些不同选择的临床结果数据。
最新发现
可移动抗生素间隔物和静态抗生素间隔物在根除感染方面没有明显差异。可移动间隔物在二期再植入后显示膝关节活动范围有所改善。两阶段翻修关节成形术是PJI的金标准治疗方法。第一阶段包括移除所有组件、骨水泥和受损的软组织，并植入抗生素浸渍间隔物。间隔物选项包括可移动间隔物和静态间隔物。可移动间隔物在分期手术之间可维持行走和关节活动范围，并且在根除感染方面已证明与静态间隔物一样有效。
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本文引用的文献
1
Infection after total knee replacement: diagnosis and treatment.
Rev Bras Ortop. 2013 Nov 6;48(5):389-396. doi: 10.1016/j.rboe.2013.01.003. eCollection 2013 Sep-Oct.
2
Infection after total knee arthroplasty and its gold standard surgical treatment: Spacers used in two-stage revision arthroplasty.
Intractable Rare Dis Res. 2017 Nov;6(4):256-261. doi: 10.5582/irdr.2017.01049.
3
Infection burden in total hip and knee arthroplasties: an international registry-based perspective.
Arthroplast Today. 2017 Jun 20;3(2):137-140. doi: 10.1016/j.artd.2017.05.003. eCollection 2017 Jun.
4
Prospective quality of life assessment after hip and knee arthroplasty: short- and mid-term follow-up results.
Arthroplast Today. 2016 Nov 15;3(2):125-130. doi: 10.1016/j.artd.2016.09.008. eCollection 2017 Jun.
5
Synovial Fluid Cell Count for Diagnosis of Chronic Periprosthetic Hip Infection.
J Bone Joint Surg Am. 2017 May 3;99(9):753-759. doi: 10.2106/JBJS.16.00123.
6
The use of spacers (static and mobile) in infection knee arthroplasty.
Curr Rev Musculoskelet Med. 2015 Dec;8(4):373-82. doi: 10.1007/s12178-015-9293-8.
7
Definition of periprosthetic joint infection.
J Arthroplasty. 2014 Jul;29(7):1331. doi: 10.1016/j.arth.2014.03.009. Epub 2014 Mar 21.
8
Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection: techniques, controversies, and outcomes.
J Am Acad Orthop Surg. 2014 Mar;22(3):153-64. doi: 10.5435/JAAOS-22-03-153.
9
Infection following total knee arthroplasty.
Knee Surg Relat Res. 2013 Sep;25(3):93-9. doi: 10.5792/ksrr.2013.25.3.93. Epub 2013 Aug 29.
10
Use of static or articulating spacers for infection following total knee arthroplasty: a systematic literature review.
J Bone Joint Surg Am. 2013 Sep 4;95(17):1594-9. doi: 10.2106/JBJS.L.01461.
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