Franceschini Massimo, Pedretti Leopoldo, Cerbone Vincenzo, Sandiford Nemandra Amir
Istituto Ortopedico "G. Pini", II Orthopaedic Clinic, University of Milan, Milan, Italy.
Joint Reconstruction Unit, Southland Hospital, Invercargill, New Zealand.
Ann Jt. 2022 Jan 15;7:4. doi: 10.21037/aoj-20-84. eCollection 2022.
Periprosthetic joint infection (PJI) is one of the most challenging complications a surgeon has to face after prosthetic replacement of a joint and one of the most devastating complications for the patient. During the 2018 International Consensus Meeting (ICM) in Philadelphia a numerical diagnostic tool was proposed. Contraindications to single stage revision include significant soft tissue injury with the inability to provide soft tissue cover, the presence of unknown or multi resistant organisms, lack of access to appropriate antibiotics or lack of appropriate expertise. Two stage revision surgery is indicated in these situations. Insall described the surgical two-stage prosthetic revision technique in 1983: the prosthesis is removed, a thorough debridement of bone and soft tissue is performed, an interval spacer is inserted, antibiotics administered. The 2 stage of definitive reconstruction is performed once the infection is deemed to have resolved. The interval between stages can range from 6 weeks to several months. PJI are very challenging for every surgeon skilled in prosthetic surgery. It's necessary to make an exact preoperative diagnosis and to treat them with the proper technique. Further studies are needed to establish the perfect timing between the two stages, the duration of the antibiotic therapy and to standardize the diagnostic chart.
人工关节周围感染（PJI）是外科医生在关节假体置换后必须面对的最具挑战性的并发症之一，也是对患者最具破坏性的并发症之一。在2018年于费城召开的国际共识会议（ICM）上，提出了一种数值诊断工具。一期翻修的禁忌证包括严重软组织损伤且无法提供软组织覆盖、存在未知或多重耐药菌、无法获得合适的抗生素或缺乏适当的专业知识。在这些情况下，应进行二期翻修手术。英萨尔于1983年描述了外科二期假体翻修技术：取出假体，对骨和软组织进行彻底清创，插入间隔物，给予抗生素。一旦感染被认为已得到解决，便进行二期确定性重建。两期之间的间隔时间可为6周至数月。对于每一位擅长假体手术的外科医生来说，PJI都是极具挑战性的。必须做出准确的术前诊断并采用适当的技术进行治疗。需要进一步研究以确定两期之间的最佳时间、抗生素治疗的持续时间，并规范诊断图表。
