膝关节置换术后感染：人工膝关节周围感染影响的定性研究
Infection after knee replacement: a qualitative study of impact of periprosthetic knee infection.
作者信息
Mallon Charlotte M, Gooberman-Hill Rachael, Moore Andrew J
机构信息
Bristol Medical School, University of Bristol, Bristol, UK.
National Institute for Health Research Bristol Biomedical Research Centre, University of Bristol, Bristol, UK.
出版信息
BMC Musculoskelet Disord. 2018 Oct 2;19(1):352. doi: 10.1186/s12891-018-2264-7.
BACKGROUND
Approximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy. This study aimed to understand and characterise patients' experiences of periprosthetic knee infection.
METHODS
Qualitative semi-structured interviews were conducted with 16 patients (9 men, 7 women; 59-80 years, mean age 72) who experienced periprosthetic knee infection and subsequent revision treatment in six National Health Service orthopaedic departments. Interviews were audio-recorded, transcribed, anonymised and analysed thematically. The concept of biographical disruption was used to frame our analysis, and four transcripts double-coded for rigour. Patients were interviewed between two and 10 months after surgical revision.
RESULTS
Participant experiences can be characterised according to three aspects of biographical disruption which we have used to frame our analysis: onset and the problem of recognition; emerging disability and the problem of uncertainty, and chronic illness and the mobilisation of resources. Participants' experiences of infection and treatment varied, but everyone who took part reported that infection and revision treatment had devastating effects on them. Participants described use of social and healthcare support and a need for more support. Some participants thought that the symptoms that they had first presented with had not been taken seriously enough.
CONCLUSIONS
Periprosthetic knee infection and its treatment can be life-changing for patients, and there is a need for greater support throughout treatment and lengthy recovery. Future work could look at preparedness for adverse outcomes, help-seeking in impactful situations, and information for healthcare professionals about early signs and care for periprosthetic infection.
背景
在美国和英国，每年大约进行34万例膝关节置换手术。接受膝关节置换手术的患者中，约有1%会在假体周围发生深部感染，即假体周围膝关节感染。治疗通常需要一种或多种大手术与抗生素治疗相结合。本研究旨在了解和描述假体周围膝关节感染患者的经历。
方法
对16例患者（9名男性，7名女性；年龄59 - 80岁，平均年龄72岁）进行了定性半结构式访谈，这些患者在六个国民保健服务（NHS）骨科部门经历了假体周围膝关节感染及后续翻修治疗。访谈进行了录音、转录、匿名处理，并进行了主题分析。采用人生经历中断的概念来构建我们的分析框架，并对四份转录本进行了双重编码以确保严谨性。患者在手术翻修后2至10个月接受访谈。
结果
参与者的经历可以根据人生经历中断的三个方面来描述，我们以此构建了分析框架：发病及识别问题；新出现的残疾及不确定性问题，以及慢性病和资源调动。参与者的感染和治疗经历各不相同，但所有参与的患者都表示感染和翻修治疗对他们产生了毁灭性影响。参与者描述了社会和医疗支持的使用情况以及对更多支持的需求。一些参与者认为他们最初出现的症状没有得到足够重视。
结论
假体周围膝关节感染及其治疗可能会改变患者的生活，在整个治疗和漫长的康复过程中需要更多支持。未来的工作可以关注不良后果的准备情况、在有影响的情况下寻求帮助，以及为医疗专业人员提供有关假体周围感染的早期迹象和护理的信息。
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