中国组织工程研究 ›› 2017, Vol. 21 ›› Issue (19): 3088-3094.doi: 10.3969/j.issn.2095-4344.2017.19.021

• 骨与关节综述 bone and joint review • 上一篇    下一篇

人工膝关节置换后感染:诊断与治疗的新话题

张 尧,徐 哲,吕 浩,冯 卫   

  1. 吉林大学白求恩第一医院骨关节外科,吉林省长春市 130021
  • 出版日期:2017-07-08 发布日期:2017-08-10
  • 通讯作者: 冯卫,副教授,副主任医师,硕士生导师,吉林大学白求恩第一医院骨关节外科,吉林省长春市 130021
  • 作者简介:张尧,男,1991年生,山东省滕州市人,汉族,吉林大学白求恩第一医院在读硕士。
  • 基金资助:

    吉林省科技厅项目(20160101131JC);吉林省卫生计生科研计划(2015Z031)

Advance in the diagnosis and treatment of infection after total knee arthroplasty

Zhang Yao, Xu Zhe, Lv Hao, Feng Wei   

  1. Department of Bone and Joint, the First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China
  • Online:2017-07-08 Published:2017-08-10
  • Contact: Feng Wei, Associate professor, Associate chief physician, Master’s supervisor, Department of Bone and Joint, the First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China
  • About author:Zhang Yao, Studying for master’s degree, Department of Bone and Joint, the First Bethune Hospital of Jilin University, Changchun 130021, Jilin Province, China
  • Supported by:

    the Project of Science and Technology Department of Jilin University, No. 20160101131JC; the Research Program of Health and Family Planning Commission of Jilin Province, No. 2015Z031

摘要:

文章快速阅读:



文题释义:
假体周围感染:是人工关节置换术后的严重并发症,保守治疗一般难以控制,常导致人工关节置换术失败。由于细菌生物膜的存在,假体周围的感染往往难以控制,给临床工作带来极大的困扰。
二期翻修:目前被认为是临床治疗慢性全膝关节置换术后感染最有效的治疗手段。标准的二期翻修步骤为取出假体和骨水泥,彻底清创,含抗生素的骨水泥spacer维持关节间隙,敏感抗生素静点4-6周后复查红细胞沉降率、C-反应蛋白水平在正常范围内且关节穿刺液细菌培养阴性后置入新的人工假体。
 
摘要
背景:随着接受人工膝关节置换的患者逐年增多,假体周围感染作为其严重并发症成为骨科医师的关注热点。
目的:总结近年来人工膝关节置换后感染诊断与治疗的研究进展。
方法:由第一作者检索至2017年1月为止 PubMed数据(http://www.ncbi.nlm.nih.gov/PubMed)及CNKI中国期刊全文数据库(http://www.cnki.net/),以“total knee arthroplasty,Infection”为英文检索词,“膝关节置换,感染”为中文检索词,检索查阅近年来国内外关于人工膝关节置换后感染诊断与治疗的相关研究报道,排除重复性研究,对人工膝关节置换后感染的危险因素、诊断、分型及治疗进行总结。
结果与结论:①人工膝关节置换后感染的危险因素与患者术前情况、手术操作及术后状态息息相关;②诊断感染要通过详细了解患者临床情况及完善的辅助检查;③治疗方式包括单纯抗生素治疗、清创保留假体、翻修术、关节融合术以及截肢;④提示假体周围感染是人工膝关节置换术后的严重并发症,早期发现及处理是治疗人工膝关节置换术后假体周围感染的关键。治疗时应根据患者的具体情况选择不同的治疗方式。

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程
ORCID: 0000-0002-3455-4701(张尧)

关键词: 骨科植入物, 人工假体, 全膝关节置换, 感染, 诊断, 治疗

Abstract:

BACKGROUND: With the prevalence of total knee arthroplasty, periprosthetic joint infection as a serious complication has been an issue of concern.

OBJECTIVE: To summarize the advances in the diagnosis and treatment of infection after total knee arthroplasty.
METHODS: The first author searched the PubMed and CNKI databases for the literatures related to the diagnosis and treatment of infection after total knee arthroplasty using the keywords of “total knee arthroplasty, infection” in English and Chinese, respectively. The repetitive articles were excluded, and the risk factors, diagnosis, classification and treatment of infection after total knee arthroplasty were summarized.
RESULTS AND CONCLUSION: (1) The infection after artificial knee replacement is closely related to the patient’s preoperative condition, operation skills and postoperative status. (2) Diagnosis of infection is based on the detailed understanding of the patients’ situation and complete auxiliary examinations. (3) The treatment methods include antibiotics, debridement and retention, reversion, arthrodesis, as well as amputation. (4) Periprosthetic infection is a serious complication after total knee arthroplasty, and early diagnosis and treatment are critical. Furthermore, choosing an appropriate individualized treatment scheme for different patients is important.

中国组织工程研究杂志出版内容重点:人工关节;骨植入物;脊柱骨折;内固定;数字化骨科;组织工程

Key words: Prosthesis Implantation, Arthroplasty, Replacement, Knee, Infection, Tissue Engineering

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