中国组织工程研究 ›› 2021, Vol. 25 ›› Issue (30): 4823-4827.doi: 10.12307/2021.268

• 人工假体 artificial prosthesis • 上一篇    下一篇

硫酸钙抗生素载体治疗关节置换后假体周围感染及对血钙的影响

高天豪,钱绘仿,杨尚良,辛超飞,陆世涛,许建中   

  1. 郑州大学第一附属医院,河南省郑州市   450052
  • 收稿日期:2020-08-26 修回日期:2020-08-28 接受日期:2020-09-19 出版日期:2021-10-28 发布日期:2021-07-29
  • 通讯作者: 许建中,博士,主任医师,郑州大学第一附属医院,河南省郑州市 450052
  • 作者简介:高天豪,男,1993年生,河南省西华县人,汉族,郑州大学第一附属医院在读硕士,主要从事髋、膝关节置换及翻修和关节镜相关手术方面的研究

Calcium sulfate antibiotic carrier in the treatment of periprosthetic infection after arthroplasty and its effect on serum calcium

Gao Tianhao, Qian Huifang, Yang Shangliang, Xin Chaofei, Lu Shitao, Xu Jianzhong    

  1. First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China 
  • Received:2020-08-26 Revised:2020-08-28 Accepted:2020-09-19 Online:2021-10-28 Published:2021-07-29
  • Contact: Xu Jianzhong, MD, Chief physician, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China
  • About author:Gao Tianhao, Master candidate, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, Henan Province, China

摘要:

文题释义:
硫酸钙抗生素载体:硫酸钙骨粉是英国百赛公司生产的一种具有生物相容性和可溶解性的抗生素缓释系统,可以在关节内持续释放高浓度抗生素。硫酸钙载体的诞生解决了以往用聚甲基丙烯酸甲酯作为抗生素释放媒介的缺点,例如不可生物降解(需二次手术取出)、在早期抗生素释放浓度及达到较低水平(有研究指出在置入后的24 h内局部抗生素释放浓度即将至初始水平的10%)及材料表面可能被病原体定植形成植入物表面生物膜;并可作为骨填充物在各种原因引起的骨缺损中发挥重要作用,是一种未来应用前景很广泛的新型材料。
假体周围感染:假体周围感染的诊疗有几大困难:诊断困难、细菌培养出来困难(术前关节液培养阳性率73%)、抗生素局部作用困难等等。2018年成立的假体周围感染小组,召集众多行业专家形成专家共识给假体周围感染的诊疗提供了较为前沿的指导。
背景:硫酸钙作为抗生素载体已经广泛应用于骨髓炎的治疗,但其在假体周围感染中的作用尚缺乏有力的研究证明。
目的:观察硫酸钙缓释系统治疗关节置换后假体周围感染的效果,及其对患者术后血钙浓度的影响。
方法:回顾性分析2019年1月至2020年4月于郑州大学第一附属医院骨六科收治的24例关节置换后假体周围感染的患者,根据患者假体周围感染分期及是否有病原学依据,分别采用关节镜下清理、切开清创、一期翻修或二期翻修进行治疗。所有患者术中均置入硫酸钙缓释系统。试验经郑州大学第一附属医院伦理委员会批准,批准号2020-KY-0229。
结果与结论:①所有患者均完成为期3个月的随访;②无症状低钙血症发生率较高,其中2例患者出现需要紧急处理的低钙血症,1例患者在术后第1天出现高钙血症,但不需要处理;患者手术前后的血清钙水平接近;③23例患者伤口愈合良好,假体位置良好,未再复发,另1例出现感染,再次施行手术后再次复发;④所有患者术后红细胞沉降率和C-反应蛋白均较术前明显降低(P < 0.01);而髋关节Harris评分和膝关节Harris评分较术前提高(P < 0.01);⑤提示硫酸钙缓释系统可有效改善关节置换后假体周围感染,且患者术后存在有较高无症状低钙血症风险。
https://orcid.org/0000-0003-2645-4070 (许建中) 

关键词: 硫酸钙, 血钙, 假体周围感染, 保留假体清创, 关节成形, 关节镜下清创, 关节翻修, 无症状低钙血症, 关节功能恢复

Abstract: BACKGROUND: Calcium sulfate, as an antibiotic carrier, has been widely used in the treatment of osteomyelitis, but its role in periprosthetic infection still needs to be further explored. 
OBJECTIVE: To observe the effects of calcium sulfate sustained-release system on the treatment of periprosthetic joint infection following arthroplasty and the postoperative serum calcium concentration.
METHODS: Retrospective analysis was performed on 24 patients who were admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University and developed periprosthetic joint infection following arthroplasty from January 2019 to April 2020. Depending on the stage of the patient’s periprosthetic joint infection and whether there was etiological evidence, the patients were treated with arthroscopic debridement, incision debridement, one-stage revision arthroplasty or two-stage revision arthroplasty. All patients were implanted with a calcium sulfate sustained-release system intraoperatively. The trial was approved by the Ethics Committee of First Affiliated Hospital of Zhengzhou University (Approval No. 2020-KY-0229). 
RESULTS AND CONCLUSIONS: (1) All patients completed the three-month follow-up. (2) The incidence of asymptomatic hypocalcemia was high. Specifically, two patients experienced hypocalcemia requiring emergency treatment, and one patient experienced hypercalcemia not requiring treatment at 1 day postoperatively. The preoperative and postoperative serum calcium levels were comparable in these patients. (3) Totally 23 patients had satisfactory wound healing, and the prosthesis was well positioned without recurrence of infection; one patient developed infection that recurred following reoperation. (4) In all the patients, erythrocyte sedimentation rate and C-reactive protein decreased significantly postoperatively (P < 0.01); Harris hip and knee scores improved postoperatively (P < 0.01). (5) These suggest that calcium sulfate sustained-release system can effectively improve periprosthetic joint infection following arthroplasty, and the patients are at a high risk of postoperative asymptomatic hypocalcemia.

Key words: calcium sulfate, serum calcium, periprosthetic joint infection, debridement antibiotics irrigation and implant retention, arthroplasty, artoroscopic debridement, arthrorevision, asymptomatic hypocalcemia, joint function recovery

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