中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (9): 1671-1674.doi: 10.3969/j.issn.1673-8225.2011.09.037

• 骨与关节学术探讨 academic discussion of the bone and joint • 上一篇    下一篇

人工全膝关节置换后的感染发病机制与诊断及治疗

衣  明，黄  荣，李书忠   

  1. 青岛大学医学院附属医院脊柱外科，山东省青岛市  266003
  • 收稿日期:2010-11-03 修回日期:2011-01-12 出版日期:2011-02-26 发布日期:2011-02-26
  • 通讯作者: 李书忠，硕士，教授，主任医师，硕士生导师，青岛大学医学院附属医院脊柱外科，山东青岛市 266003 qylsz8328@163.com
  • 作者简介:衣明，男，1969年生，山东省即墨市人，汉族，2008年济宁医学院毕业，主治医师，主要从事骨科学的研究。 www.hr.2008@163.com

Research progress of the pathogenesis, diagnosis and treatment of infections following total knee replacement

Yi Ming, Huang Rong, Li Shu-zhong   

  1. Department of Spinal Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao  266003, Shandong Province, China
  • Received:2010-11-03 Revised:2011-01-12 Online:2011-02-26 Published:2011-02-26
  • Contact: Li Shu-zhong, Master, Professor, Chief physician, Master’s supervisor, Department of Spinal Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, Shandong Province, China qylsz8328@163.com
  • About author:Yi Ming, Attending physician, Department of Spinal Surgery, the Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, Shandong Province, China www.hr.2008@163.com

PDF

322

被引次数

12

摘要：

背景：假体周围感染已成为全膝关节置换后常见的并发症，了解其发病机制，早期及时的做出诊断，并制定出最佳的治疗方案对全膝关节置换的预后非常重要。
目的：综述近几年关于人工全膝关节置换后的感染发病机制与诊断治疗的最新进展。
方法：应用计算机检索1982-01/2009-12 CNKI数据库、Pubmed数据库相关文章，检索词为“人工膝关节置换，感染，total knee arthroplasty，infection”，共检索到文献2 673篇。此外手工查阅相关专著数部。最终纳入符合标准的文献34篇。
结果与结论：假体表面形成一层保护性的生物膜是抗生素难以将病原微生物灭除的主要原因。血液化验、细菌学培养及影像学检查是诊断全膝关节置换的有效手段，但各有优点及不足，诊断时应结合各种检查结果综合考虑。目前，全膝关节置换的治疗方式主要有单纯应用抗生素、清创保留假体、彻底清创一期或二期假体再置换、关节融合和关节离断等治疗方式，每种治疗方案都有其适应证，应根据患者的具体病情采用合适的治疗方法。

关键词: 人工膝关节置换, 感染, 发病机制, 诊断, 治疗, 综述文献

Abstract:

BACKGROUND: Periprosthetic infection remains one of the most devastating and costly complications after total knee replacement. It is very important for the prognosis of total knee replacement that understanding its pathogenesis, make an accurate diagnosis timely, and to develop the appropriate treatment.
OBJECTIVE: To summarize the research progress regarding pathogenesis, diagnosis and treatment of infections after total knee replacement.
METHODS: A computer-based online search of CNKI between January 1982 and December 2009 and PUBMED database was performed to search related articles with the key words of “total knee arthroplasty; infection”. A total of 2 673 articles were retrieved. Moreover, related works were manually searched. Totally 34 articles were included. 
RESULTS AND CONCLUSION: The biofilm on phantom surface protects the microbiologic not eradicated by antibiotics. Blood tests, bacteriological culture and imaging are effective procedures for the diagnosis of total knee replacement. But they all have disadvantages, which should be considered. Currently, the treatment modalities of total knee replacement are antibiotics, debridement and prosthesis retention, thorough debridement and one or two-stage reimplantation, arthrodesis, disarticulation and other treatments. The orthopaedic surgeon uses an essential armamentarium of diagnostic and treatment options to determine the presence of infection and tailor the individual treatment for each patient.

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