CAJ | 학술논문

目的总结关节型抗生素骨水泥间隔体技术治疗全膝关节置换术后迟发深部感染的技术要点与初步经验.方法 2006年1月至2009年2月接受二期翻修治疗的全膝关节置换术后迟发深部感染患者21例(21膝),男8例,女13例;年龄56～83岁,平均64.4岁.一期手术中彻底清创,取出假体,植入含高浓度万古霉素的关节型骨水泥间隔体;术后静脉滴注敏感抗生素2～8周,感染控制后二期植入翻修假体.结果全部患者获得随访,随访时间17～54个月,平均32.2个月.无一例出现感染复发.终末随访时,KSS膝关节评分、功能评分、疼痛评分及膝关节活动范围均较术前明显改善,伸膝迟滞程度无明显加重.两次手术间隔平均11.5周.间隔体取出前后骨缺损程度未见明显改变.治疗期间未见明显肝、肾功能异常及伤口愈合不良、深静脉血栓形成、肺栓塞、心脑血管意外等并发症.结论应用关节型抗生素骨水泥间隔体技术可在一定程度上保持间隔期内的膝关节功能、避免骨量丢失,相关并发症少.彻底清创、间隔期内使用敏感抗生素、准确判断翻修假体植入时机是治疗成功的关键.
목적 총결관절형항생소골수니간격체기술치료전슬관절치환술후지발심부감염적기술요점여초보경험.방법 2006년1월지2009년2월접수이기번수치료적전슬관절치환술후지발심부감염환자21례(21슬),남8례,녀13례;년령56～83세,평균64.4세.일기수술중철저청창,취출가체,식입함고농도만고매소적관절형골수니간격체;술후정맥적주민감항생소2～8주,감염공제후이기식입번수가체.결과 전부환자획득수방,수방시간17～54개월,평균32.2개월.무일례출현감염복발.종말수방시,KSS슬관절평분、공능평분、동통평분급슬관절활동범위균교술전명현개선,신슬지체정도무명현가중.량차수술간격평균11.5주.간격체취출전후골결손정도미견명현개변.치료기간미견명현간、신공능이상급상구유합불량、심정맥혈전형성、폐전새、심뇌혈관의외등병발증.결론 응용관절형항생소골수니간격체기술가재일정정도상보지간격기내적슬관절공능、피면골량주실,상관병발증소.철저청창、간격기내사용민감항생소、준학판단번수가체식입시궤시치료성공적관건.
Objective To detail our early experience on a modified two-stage revison using articulating antibiotic-loaded cement spacer (AALCS) for late periprosthetic infection of total knee arthroplasty (TKA).Methods From January 2006 to February 2009,a series of 21 patients (21 knees) underwent twostage revision knee arthroplasty for late infected TKA.There were 8 males and 13 females,aged from 56 to 83 years (average,64.4 years).In the first stage,each patient underwent radical debridement,removal of all components and cement,and implantation of articulating cement spacer containing vancomycin.Graduated knee motion and partial weight bearing activity were encouraged in the interval period.Each patient received an individual systemic organism-sensitive antimicrobial therapy for 4.9 weeks (range,2-8 weeks) followed by a second-stage revision TKA.All the patients were regularly followed-up using the American Knee Society Scoring System.Results All patients were followed up for 17 to 54 months (average,32.2 months).At final follow-up,the knee society score,function score,pain score and range of motion (ROM) of knee were significantly improved compared with those before operation.Meanwhile,there was no significant increase in the degree of extension lag.The average interval period was 11.5 weeks (range,6-32 weeks).No change of bone defect volume was found between two stages.There were no complications such as recurrent infection,hepatic and renal dysfunction,and deep venous thrombosis.Conclusion Treating infected TKA with AALCS can avoid spacer-related bone loss,preserve knee function between two stages,and eradicate infection effectively without significant complications.The early clinical results are inspiring.Radical debridement,individual application of systemic antibiotics,and reasonable juncture for the second revision are all key factors related to a successful outcome.