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人工膝关节周围感染 - 第2部分:治疗

Periprosthetic Knee Infection - Part 2: Treatment.

作者信息

Barretto João Maurício, Campos André Luiz Siqueira, Ooka Nelson Hiroyuki Miyabe

机构信息

Hospital São Vicente da Gávea, Rio de Janeiro, RJ, Brasil.

Departamento de Ortopedia e Traumatologia, Hospital Federal dos Servidores do Estado, Rio de Janeiro, RJ, Brasil.

出版信息

Rev Bras Ortop (Sao Paulo). 2022 May 27;57(2):193-199. doi: 10.1055/s-0041-1729936. eCollection 2022 Apr.

Abstract

Several treatment modalities are proposed for periprosthetic infections, with variable success rates. However, efficacy is related to the appropriate selection of cases for each type of treatment. Debridement with implant retention is indicated in acute infections with fixed implant, and its success depends on the type of infection, comorbidities of the host, and virulence of the etiological agent. One- or two-stage revision is required in cases in which biofilm is forming, or of implant loosening. The choice between performing the review in one or two stages depends on factors such as etiological agent identification, pathogen virulence, local and systemic host factors. Rescue procedures such as arthrodesis, amputation, resection arthroplasty or even antibiotic suppression are reserved for cases in which the infection has not been eradicated.

摘要

针对假体周围感染提出了几种治疗方式,成功率各不相同。然而,疗效与每种治疗类型的病例选择是否恰当有关。对于固定假体的急性感染,可采用保留假体的清创术,其成功与否取决于感染类型、宿主的合并症以及病原体的毒力。在形成生物膜或假体松动的情况下,需要进行一期或二期翻修。一期翻修和二期翻修的选择取决于病原体鉴定、病原体毒力、局部和全身宿主因素等。对于感染未根除的病例,则采用关节融合术、截肢术、切除关节成形术甚至抗生素抑制等挽救措施。

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本文引用的文献

1
Irrigation and Debridement, Modular Exchange, and Implant Retention for Acute Periprosthetic Infection After Total Knee Arthroplasty.
JBJS Essent Surg Tech. 2019 Nov 1;9(4). doi: 10.2106/JBJS.ST.19.00019. eCollection 2019 Oct-Dec.
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Orthop Surg. 2020 Feb;12(1):38-49. doi: 10.1111/os.12545. Epub 2019 Dec 1.
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Definitive Resection Arthroplasty of the Knee: A Surprisingly Viable Treatment to Manage Intractable Infection in Selected Patients.
J Arthroplasty. 2020 Mar;35(3):855-858. doi: 10.1016/j.arth.2019.10.025. Epub 2019 Oct 19.
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Persistent Fistula for Treatment of a Failed Periprosthetic Joint Infection: Relic From the Past or a Viable Salvage Procedure?
J Arthroplasty. 2020 Feb;35(2):544-549. doi: 10.1016/j.arth.2019.09.012. Epub 2019 Sep 14.
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Outcome of single-stage versus two-stage exchange for revision knee arthroplasty for chronic periprosthetic infection.
EFORT Open Rev. 2019 Aug 2;4(8):495-502. doi: 10.1302/2058-5241.4.190003. eCollection 2019 Aug.

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