感染性膝关节置换术中清创失败、使用抗生素及保留植入物的结局：别无选择。
The Fate of Failed Debridement, Antibiotics, and Implant Retention in Infected Knee Arthroplasties: Nothing to Lose.
作者信息
Öztürk Özkan, Özdemir Mahmut, Turgut Mehmet Cenk, Altay Murat
机构信息
Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, TUR.
Department of Orthopedics and Traumatology, VM Medical Park Hospital, Ankara, TUR.
出版信息
Cureus. 2021 Oct 21;13(10):e18946. doi: 10.7759/cureus.18946. eCollection 2021 Oct.
Purpose The frequency of periprosthetic knee infections increases yearly because of the popularity of the total knee prostheses. Revision knee arthroplasty is an annoying problem for both the surgeons and the patients. Debridément, antibiotics, and implant retention (DAIR) is a popular alternative for the treatment of periprosthetic knee infections. Little is known about the fate of the failed DAIR patients. This study aims to investigate the effect of the failed DAIR on the clinical result after two-staged revision arthroplasty. Method Ninety-nine two-staged revision arthroplasties and 85 DAIR patients from two reference clinics were retrospectively analyzed. The minimum follow-up was 36 months. Patients were grouped according to the treatment as, two-staged revision without DAIR, two-staged revision after failed DAIR, and successful DAIR. Their Knee Society Scores (KSS), functional KSS (KSS-f) and Western Ontario and McMaster Universities Arthritis Index (WOMAC) scores were analyzed and compared. Results DAIR has a 52.9% success rate for the treatment of infection. Elevated erythrocyte sedimentation rates and C-reactive peptide levels are not risk factors for failure, but the time passed since the index surgery is a risk factor for worse outcome scores. Failed DAIR is not a risk factor for reinfection after two-staged revision. Last KSS after failed DAIR, successful DAIR, and two-staged revision were 83.98±7.033, 91.89±4.386, and 91.38±4.735, respectively. Last KSS-f after failed DAIR, successful DAIR, and two-staged revision were 86.25±9.524, 94.56±8.106, and 94.85±5.996, respectively. Last WOMAC after failed DAIR, successful DAIR, and two-staged revision were 86.16±7.745, 94.750±4.964, and 93.319±5.961, respectively. Conclusion Failed DAIR is associated with lesser, but still good, or excellent clinical scores. DAIR is suggested as a promising treatment option for periprosthetic knee infections in well-selected patients.
目的 由于全膝关节置换术的普及，人工膝关节周围感染的发生率逐年上升。翻修膝关节置换术对外科医生和患者来说都是一个棘手的问题。清创、抗生素治疗和保留植入物（DAIR）是治疗人工膝关节周围感染的一种常用替代方法。对于DAIR治疗失败的患者的转归了解甚少。本研究旨在探讨DAIR治疗失败对二期翻修置换术后临床结果的影响。方法 回顾性分析来自两家参考诊所的99例二期翻修置换术患者和85例接受DAIR治疗的患者。最短随访时间为36个月。根据治疗方式将患者分为未行DAIR的二期翻修组、DAIR治疗失败后的二期翻修组和DAIR治疗成功组。分析并比较他们的膝关节协会评分（KSS）、功能KSS（KSS-f）以及西安大略和麦克马斯特大学关节炎指数（WOMAC）评分。结果 DAIR治疗感染的成功率为52.9%。红细胞沉降率和C反应蛋白水平升高不是治疗失败的危险因素，但距初次手术的时间是导致结局评分较差的危险因素。DAIR治疗失败不是二期翻修后再次感染的危险因素。DAIR治疗失败组、DAIR治疗成功组和二期翻修组的末次KSS分别为83.98±7.033、91.89±4.386和91.38±4.735。DAIR治疗失败组、DAIR治疗成功组和二期翻修组的末次KSS-f分别为86.25±9.524、94.56±8.106和94.85±5.996。DAIR治疗失败组、DAIR治疗成功组和二期翻修组的末次WOMAC分别为86.16±7.745、94.750±4.964和93.319±5.961。结论 DAIR治疗失败与较低但仍良好或优秀的临床评分相关。对于精心挑选的患者，DAIR被认为是治疗人工膝关节周围感染的一种有前景的治疗选择。
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