Vaz Kenneth, Taylor Adrian, Kendrick Ben, Alvand Abtin
Nuffield Orthopaedic Centre and University of Oxford, Botnar Research Centre, Oxford, UK.
Ann Jt. 2022 Jan 15;7:5. doi: 10.21037/aoj-20-89. eCollection 2022.
Debridement, antibiotics, and implant retention (DAIR) is an alternative management strategy for the treatment of periprosthetic joint infection (PJI). While infection eradication rates are lower with DAIR, the benefits including decreased morbidity, improved functional outcomes, and decreased cost may justify the risks when considering this form of treatment compared to traditional one or two stage exchange arthroplasty. Implant longevity in the setting of a successful DAIR is similar to matched patients who have not experienced a PJI. An experienced arthroplasty surgeon well versed in extensile exposure should perform the DAIR. This procedure should not be viewed as a simple "washout." While PJI may be considered a surgical urgency, DAIR can be performed on a planned list if it allows for appropriate staffing and implants for the procedure. Arthroscopic irrigation may be performed for a patient in extremis but it should not be viewed as a definitive procedure to address PJI. Keys to a successful DAIR include accurate tissue sampling to determine the infective organism, meticulous, radical debridement, and exchange of modular components if possible. A multidisciplinary team (MDT) including an infectious disease specialist should be involved prior to surgery in order to guide appropriate antimicrobial therapy throughout the patient's course of treatment. In the article below we present our indications, considerations, and technique for performing a DAIR for PJI for hip and knee arthroplasty.
清创、抗生素及植入物保留（DAIR）是治疗人工关节周围感染（PJI）的一种替代管理策略。虽然DAIR的感染根除率较低，但与传统的一期或二期翻修关节成形术相比，其益处包括发病率降低、功能结局改善和成本降低，在考虑这种治疗方式时，这些益处可能足以抵消风险。成功实施DAIR后植入物的使用寿命与未发生PJI的匹配患者相似。应由一位精通广泛暴露技术的经验丰富的关节成形术外科医生进行DAIR。此手术不应被视为简单的“冲洗”。虽然PJI可能被视为一种外科急症，但如果DAIR手术能保证有合适的人员配备和手术所需的植入物，也可以安排在计划手术清单中进行。对于病情危急的患者可进行关节镜冲洗，但不应将其视为治疗PJI的确定性手术。成功实施DAIR的关键包括准确采集组织样本以确定感染病原体、细致彻底的清创以及尽可能更换模块化组件。术前应组建包括感染病专科医生在内的多学科团队（MDT），以便在患者整个治疗过程中指导适当的抗菌治疗。在下面的文章中，我们介绍了对髋关节和膝关节置换术后PJI实施DAIR的适应症、注意事项及技术。
