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延长抗生素使用时间可提高翻修全关节置换术后冲洗清创的生存率。

Increased antibiotic duration improves survival of irrigation and debridement after revision total joint arthroplasty.

作者信息

Bene Nicholas, Li Xing, Nandi Sumon

机构信息

Tufts University School of Medicine, Boston, MA, USA.

Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

出版信息

J Orthop. 2019 Nov 18;19:84-88. doi: 10.1016/j.jor.2019.11.020. eCollection 2020 May-Jun.

DOI:10.1016/j.jor.2019.11.020
PMID:32025113
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6997659/
Abstract

BACKGROUND

We sought to evaluate reoperation-free survival following I&D with modular component exchange of revision total joint arthroplasty (TJA).

METHODS

Of revision TJAs from 2004 to 2012 (n = 4,166), 30 were I&D with modular component exchange after index revision for aseptic indications. Patients with (n = 12) and without (n = 18) reoperation for infection recurrence were analyzed.

RESULTS

Reoperation-free survival (60% at mean 4.8 year follow-up) improved with increased duration of antibiotic therapy (p = 0.0185), with maximum benefit at 2 years.

CONCLUSIONS

At least 2 years of antibiotic therapy should be administered after I&D with modular component exchange for acutely infected revision TJA.

LEVEL OF EVIDENCE

Level III, retrospective comparative study.

摘要

背景

我们试图评估在翻修全关节置换术（TJA）中进行切开引流及模块化组件更换后的无再次手术生存率。

方法

在2004年至2012年的翻修TJA病例（n = 4166）中，30例因无菌性指征进行初次翻修后接受了切开引流及模块化组件更换。对有（n = 12）和无（n = 18）感染复发再次手术的患者进行了分析。

结果

随着抗生素治疗时间的延长，无再次手术生存率（平均随访4.8年时为60%）有所提高（p = 0.0185），在2年时获益最大。

结论

对于急性感染的翻修TJA，在切开引流及模块化组件更换后应给予至少2年的抗生素治疗。

证据水平

III级，回顾性比较研究。

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本文引用的文献

1
Factors affecting failure of irrigation and debridement with liner exchange in total knee arthroplasty infection.全膝关节置换术后感染行衬垫更换时影响冲洗清创失败的因素。
Knee. 2018 Oct;25(5):932-938. doi: 10.1016/j.knee.2018.07.003. Epub 2018 Aug 13.
2
Increased antibiotic duration improves reoperation free survival after total hip arthroplasty irrigation and debridement.全髋关节置换术后冲洗清创时延长抗生素使用时间可提高无再次手术生存率。
J Orthop. 2018 May 7;15(2):707-710. doi: 10.1016/j.jor.2018.05.014. eCollection 2018 Jun.
3
Is There Still a Role for Irrigation and Debridement With Liner Exchange in Acute Periprosthetic Total Knee Infection?在急性人工全膝关节感染中，进行衬垫置换时的冲洗和清创是否仍有作用？
J Arthroplasty. 2017 Apr;32(4):1280-1284. doi: 10.1016/j.arth.2016.10.029. Epub 2016 Nov 1.
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Long Term Treatment Results for Deep Infections of Total Knee Arthroplasty.
J Arthroplasty. 2015 Sep;30(9):1623-8. doi: 10.1016/j.arth.2015.04.008. Epub 2015 Apr 11.
5
Comparative Epidemiology of Revision Arthroplasty: Failed THA Poses Greater Clinical and Economic Burdens Than Failed TKA.翻修关节成形术的比较流行病学：失败的全髋关节置换术比失败的全膝关节置换术带来更大的临床和经济负担。
Clin Orthop Relat Res. 2015 Jun;473(6):2131-8. doi: 10.1007/s11999-014-4078-8. Epub 2014 Dec 3.
6
Gram-negative prosthetic joint infection: outcome of a debridement, antibiotics and implant retention approach. A large multicentre study.革兰氏阴性假体关节感染：清创术、抗生素和保留植入物方法的结果。一项大型多中心研究。
Clin Microbiol Infect. 2014 Nov;20(11):O911-9. doi: 10.1111/1469-0691.12649. Epub 2014 Jun 14.
7
Impact of the economic downturn on total joint replacement demand in the United States: updated projections to 2021.美国经济衰退对全关节置换需求的影响：更新至 2021 年的预测。
J Bone Joint Surg Am. 2014 Apr 16;96(8):624-30. doi: 10.2106/JBJS.M.00285.
8
Current modes of failure in TKA: infection, instability, and stiffness predominate.目前全膝关节置换术的失败模式主要为感染、不稳定和僵硬。
Clin Orthop Relat Res. 2014 Jul;472(7):2197-200. doi: 10.1007/s11999-014-3540-y. Epub 2014 Mar 11.
9
Acute hematogenous infection following total hip and knee arthroplasty.全髋关节和膝关节置换术后的急性血源性感染
J Arthroplasty. 2014 Mar;29(3):469-72. doi: 10.1016/j.arth.2013.07.021. Epub 2013 Aug 30.
10
Failure of irrigation and débridement for early postoperative periprosthetic infection.早期术后假体周围感染的灌洗和清创失败。
Clin Orthop Relat Res. 2013 Jan;471(1):250-7. doi: 10.1007/s11999-012-2373-9.