Calanna Filippo, Chen Foster, Risitano Salvatore, Vorhies John S, Franceschini Massimo, Giori Nicholas J, Indelli Pier Francesco
Istituto Ortopedico Gaetano Pini, Division of Orthopaedic Surgery, Milan, Italy.
Department of Orthopaedic Surgery, Stanford University, Stanford, CA, USA.
J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3):2309499019874413. doi: 10.1177/2309499019874413.
We describe a modified surgical technique developed to enhance the classical irrigation and debridement procedure to improve the possibilities of retaining an infected total knee arthroplasty. This technique, debridement antibiotic pearls and retention of the implant (DAPRI), aims to remove the intra-articular biofilm allowing a higher and prolonged local antibiotic concentration using calcium sulfate beads. The combination of three different surgical techniques (methylene blue staining, argon beam electrical stimulation, and chlorhexidine gluconate brushing) might enhance the identification, disruption, and finally removal of the bacterial biofilm, which is the main responsible of antibiotics and antibodies resistance. The DAPRI technique might represent a safe and more conservative treatment for acute and early hematogenous periprosthetic joint infection.
我们描述了一种改良的手术技术，该技术旨在强化经典的冲洗清创术，以提高保留感染的全膝关节置换术的可能性。这种技术，即清创抗生素珠粒与植入物保留术（DAPRI），旨在通过硫酸钙珠粒去除关节内生物膜，从而实现更高且持久的局部抗生素浓度。三种不同手术技术（亚甲蓝染色、氩束电刺激和葡萄糖酸洗必泰刷洗）的联合应用可能会增强细菌生物膜的识别、破坏并最终将其清除，而细菌生物膜是导致抗生素和抗体耐药的主要原因。DAPRI技术可能是治疗急性和早期血源性假体周围关节感染的一种安全且更为保守的方法。
