CAJ | 학술논문

目的探讨运用可活动关节间隔垫技术治疗有内科基础病及局部窦道形成的严重全膝关节置换术后感染的疗效和安全性.方法 2002年1月至2008年3月,10例全膝关节置换术后延迟感染患者,男3例,女7例;年龄23～73岁,中位年龄67岁.患者均采用二期再置换手术治疗:第一期手术,取出假体、彻底清创,并植入含抗生素的可活动间隔垫,切除窦道,封闭原窦道口.术后予以积极抗感染和功能康复治疗.待感染控制后行第二期手术,取出可活动间隔垫,植入新的关节假体.采用美国特种外科医院(the hospital for special surgery,HSS)膝关节评分以及膝关节活动度评价治疗效果.结果 1例患者治疗期间血糖控制不佳,一期手术后感染未得到控制而行关节融合术,另外9例患者感染均获治愈.随访时间24～90个月,平均50个月.随访期内无一例发生感染复发及并发症,患者无膝周肿痛等不适主诉.术前患膝HSS评分32～63分,平均48分;二期手术前HSS评分62～91分,平均79分;末次随访时HSS评分74～95分,平均89分.术前、二期术前以及二期术后患膝关节功能的优良率分别为0、80%和100%.术前膝关节活动度为13°～70°,一期术后膝关节活动度为8°～93°,末次随访时膝关节活动度为3°～110°.结论可活动关节间隔垫技术是治疗全膝关节置换术后严重感染的一种安全、有效的方法,可在控制感染的基础上尽可能保留关节功能.
목적 탐토운용가활동관절간격점기술치료유내과기출병급국부두도형성적엄중전슬관절치환술후감염적료효화안전성.방법 2002년1월지2008년3월,10례전슬관절치환술후연지감염환자,남3례,녀7례;년령23～73세,중위년령67세.환자균채용이기재치환수술치료:제일기수술,취출가체、철저청창,병식입함항생소적가활동간격점,절제두도,봉폐원두도구.술후여이적겁항감염화공능강복치료.대감염공제후행제이기수술,취출가활동간격점,식입신적관절가체.채용미국특충외과의원(the hospital for special surgery,HSS)슬관절평분이급슬관절활동도평개치료효과.결과 1례환자치료기간혈당공제불가,일기수술후감염미득도공제이행관절융합술,령외9례환자감염균획치유.수방시간24～90개월,평균50개월.수방기내무일례발생감염복발급병발증,환자무슬주종통등불괄주소.술전환슬HSS평분32～63분,평균48분;이기수술전HSS평분62～91분,평균79분;말차수방시HSS평분74～95분,평균89분.술전、이기술전이급이기술후환슬관절공능적우량솔분별위0、80%화100%.술전슬관절활동도위13°～70°,일기술후슬관절활동도위8°～93°,말차수방시슬관절활동도위3°～110°.결론 가활동관절간격점기술시치료전슬관절치환술후엄중감염적일충안전、유효적방법,가재공제감염적기출상진가능보류관절공능.
Objective To investigate the efficiency and safety of articulating spacer for severe infected knee arthroplasty in patients with medical comorbidities and local sinus tracts. Methods Ten consecutive patients with medical comorbidities (rheumatoid arthritis, diabetes mellitus, etc) or local sinus tracts,who were complicated with late infected TKA, were included in the study. All the patients underwent twostage revision using articulating spacers. All of the patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer. Two-stage revisions were not followed untill the infection were controlled. The hospital for special surgery (HSS) knee scoring system and range of motion were used to evaluate the outcomes. Results One patient underwent knee fusion because the infection was not controlled after first-stage surgery. The other 9 patients had no evidence of infection. The mean follow-up was 50 months (range, 24-90 months), no recurrent infection developed for these 9 patients. The mean modified HSS score had improved from 48 points (range, 32-63) before the resection surgery to 79 points (range,62-91) at the end of the spacer period. At the latest follow-up, the modified HSS score averaged 89 points (range, 74-95). The good and excellent rate was 0, 80% and 100%, respectively. The average range of motion had increased from 13°-70° preoperatively to 8°-93° prior to the revision. And at the latest follow-up, the range of motion averaged 3° to 110°. Conclusion The delayed two-stage revision using an articulating spacer is effective in the treatment of chronically infected TKA characterized by simple, good reproducible, high rate of infection control, better joint function after surgeries