人工关节周围感染：我们该如何诊断和治疗？一项在线调查的结果，并与国际建议进行比较。
Periprosthetic infections: How do we diagnose and treat? Results of an online survey and comparison with international recommendations.
机构信息
Department of Orthopaedic Surgery, University of Cologne, Cologne, Germany.
Department of Radiology, University of Cologne, Cologne, Germany.
出版信息
Orthop Surg. 2021 Jul;13(5):1639-1645. doi: 10.1111/os.13052. Epub 2021 Jun 17.
OBJECTIVE
Endoprosthetic replacement surgery of hip and knee joints is widely performed, but always carries the risk of developing periprosthetic infection (PPI). Treatment of PPI is lengthy and demanding for the patient, often involving multiple surgeries as well as lengthy drug therapies. Remediation is not always successful despite extensive therapy.
METHODS
An online survey was used to investigate whether the therapeutic measures implemented in German hospitals are based on international treatment recommendations. For this purpose, German physicians who regularly treat periprosthetic infections in their clinics were asked to complete an online questionnaire. The questionnaire asked about internal hospital procedures. These were then compared with international recommendations.
RESULTS
With a response rate of 10.9%, the questionnaire shows agreement with the international recommendations in large parts of the operative and medicinal procedures. In preoperative imaging for example, two-plane radiographs are the standard. Similarly, the participants' approach to preoperative specimen collection, incubation time, and operative management (regarding one- or two-stage approach to septic joint) reflects the recommendations. Deviations were particularly evident in the area of laboratory diagnostics, where the erythrocyte sedimentation rate (ESR) is determined in only 17.1%, contrary to the recommendations. Whereas procalcitonin (PCT) and blood culture sampling takes place regularly. Clear differences emerges in the use of drains, which, contrary to the recommendations, are used very regularly (almost 70%). In this survey, the time intervals between the onset of infection symptoms and the start of therapy (prosthesis-preserving therapy) is shown to be longer than recommended internationally.
CONCLUSION
In summary, however, the recommended approaches of the international groups in most respects are followed, a high willingness of respondents to collaborate with local infectious disease specialists demonstrates the complexity of the disease.
目的
髋关节和膝关节的人工关节置换手术应用广泛，但始终存在发生假体周围感染（PPI）的风险。治疗 PPI 对患者来说既漫长又苛刻，通常需要多次手术和长期的药物治疗。尽管进行了广泛的治疗，修复并不总是成功的。
方法
我们使用在线调查来研究德国医院实施的治疗措施是否基于国际治疗建议。为此，我们要求经常在诊所治疗假体周围感染的德国医生填写在线问卷。问卷询问了医院内部的程序。然后将这些程序与国际建议进行比较。
结果
在 10.9%的回复率下，问卷显示在手术和药物治疗的大部分方面都与国际建议一致。例如，术前影像学检查采用双平面 X 线片作为标准。同样，参与者在术前标本采集、孵育时间和手术管理方面（关于一期或二期治疗感染性关节）的方法也反映了这些建议。在实验室诊断领域，特别是红细胞沉降率（ESR）的测定方面，存在明显的偏差，只有 17.1%的患者进行了测定，这与建议相反。而降钙素原（PCT）和血培养采样则经常进行。引流管的使用存在明显差异，与建议相反，引流管的使用非常频繁（近 70%）。在这项调查中，感染症状出现与开始治疗（保假体治疗）之间的时间间隔比国际上建议的时间间隔要长。
结论
然而，总的来说，大多数方面都遵循了国际组织推荐的方法，受访者高度愿意与当地传染病专家合作，这表明该疾病的复杂性。
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