中国组织工程研究

中国组织工程研究 ›› 2019, Vol. 23 ›› Issue (32): 5195-5202.doi: 10.3969/j.issn.2095-4344.1462

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

关节置换后假体周围感染的规范化治疗

刘思杰，鄂晓强，潘  琦，么贵军   

  1. 哈尔滨医科大学附属第一医院骨一科，黑龙江省哈尔滨市  150000
  • 出版日期:2019-11-18 发布日期:2019-11-18
  • 通讯作者: 鄂晓强，博士，副主任医师，副教授，哈尔滨医科大学附属第一医院骨一科，黑龙江省哈尔滨市 150000
  • 作者简介:刘思杰，男，1993年生，湖北省应城市人，汉族，哈尔滨医科大学在读硕士，医师，主要从事骨科方面的研究。
  • 基金资助:

    国家自然科学基金青年科学基金项目(81301530)，课题名称：关节炎发生的新机制——Wnt-β-catenin通过FOXP3参与调控调节性T细胞，项目负责人：鄂晓强|黑龙江省教育厅科学技术研究项目(12541334)，课题名称：类风湿关节炎中β受体-cAMP-PKA通路对调节性T细胞的作用研究，项目负责人：鄂晓强

Standardized treatment of infection around the prosthesis after joint replacement

Liu Sijie, E Xiaoqiang, Pan Qi, Yao Guijun   

  1. First Department of Orthopedics, First Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
  • Online:2019-11-18 Published:2019-11-18
  • Contact: E Xiaoqiang, MD, Associate chief physician, Associate professor, First Department of Orthopedics, First Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
  • About author:Liu Sijie, Master candidate, Physician, First Department of Orthopedics, First Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
  • Supported by:

    the Youth Science Foundation Project of National Natural Science Foundation of China, No. 81301530 (to EXQ)| the Science and Technology Research Project of Education Department of Heilongjiang Province, No. 12541334 (to EXQ)

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摘要：

文章快速阅读：

文题释义：
关节置换：是指采用金属、高分子聚乙烯、陶瓷等材料，根据人体关节的形态、构造及功能制成人工关节假体，通过外科技术置入人体内，代替患病关节功能，达到缓解关节疼痛、恢复关节功能的目的。膝关节置换和髋关节置换是人工关节置换术中最常见的2类手术，其10年的成功率已经超过90%，更有80%以上的患者可以正常使用置入的假体长达20年以上，甚至伴随其终生。
关节置换后假体周围感染：人工关节置换后发生化脓性感染是极严重的并发症。虽然感染率已由早年的10%左右降到目前的1%-3%，但由于人工关节置换术应用越来越广泛数量日益增多，出现并发感染的患者也逐渐增多。最常见为葡萄球菌感染，占70%-80%，革兰阴性杆菌、厌氧菌和非A族链球菌感染也常见。
 
摘要
背景：虽然关节置换围术期处置已经形成了一套标准化的流程，但是关节置换后假体周围感染仍是一个尚未彻底解决的难题，治疗方案依然没有达成共识。随着患者的不断增多，迫切需要具有指南意义的规范化治疗方案。
目的：综述近年国外关节置换后假体周围感染的研究进展。
方法：第一作者应用计算机检索1998至2019年PubMed数据库、Springerlink数据库的相关文章，英文检索词“Joint replacement，Periprosthetic joint infection，Progress in diagnosis and treatment”；共检索到400余篇相关文献，50篇文献符合纳入标准。
结果与结论：①随着新型血清标志物α-防御素和白细胞酯酶及D-二聚体、新型核医学检验方法及利用代谢组学和蛋白质组学等新方法的提出，可以凭借早期感染的生物标志物发现和诊断假体周围感染；②此外可以利用新的技术来破坏生物膜、微生物繁殖过程以及定量分子方法来提高病原体鉴定的准确性；③随着这些假体周围感染治疗进展的出现，快速、准确、经济的方法可能使明确诊断及培养出致病菌成为一件简单的事，那么很多病例都可以选择一期翻修；如若软组织条件不好或者不满足一期翻修的条件，则可进入二期翻修；④明确致病微生物，可以使用敏感的药物进行治疗，为二期翻修做好充足的准备，这对于假体周围感染治疗具有划时代的意义。



ORCID: 0000-0001-6218-339X(刘思杰)
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

关键词: 关节置换, 假体周围感染, α-防御素, 白细胞酯酶, D-二聚体, 新型核医学检验方法, 代谢组学, 蛋白质组学, 一期翻修, 二期翻修, 国家自然科学基金

Abstract:

BACKGROUND: Although perioperative management of arthroplasty has resulted in a standardized process, the infection around the prosthesis after arthroplasty is still a difficult problem that has not been solved completely. There is still no consensus on treatment options for infection around the prosthesis after joint replacement. With the increasing number of patients, there is an urgent need for standardized treatment options with guidance significance.
OBJECTIVE: To review the research progress of peripheral infection of prosthesis after joint replacement in foreign countries in recent years.
METHODS: The first author applied computer to retrieve the relevant articles of PubMed and Springerlink databases from 1998 to 2019. The key words were “joint replacement; periprosthetic joint infection; progress in diagnosis and treatment”. A total of 400 relevant literatures were retrieved and 50 documents met the inclusion criteria.
RESULTS AND CONCLUSION: (1) With the proposal of new serum markers such as alpha-defensin and leukocyte esterase and D-dimer, novel nuclear medical testing methods and the use of metabolomics and proteomics, periprosthetic joint infection can be found and diagnosed with early infection biomarkers. (2) In addition, new techniques can be used to disrupt biofilms, microbial reproduction processes and quantitative molecular methods to improve the accuracy of pathogen identification. (3) With the advent of these periprosthetic joint infection treatments, a rapid, accurate, and economical approach may make it easy to clearly diagnose and develop pathogens, so many cases can choose to be renovated in one phase. If soft tissue conditions are poor or do not meet the conditions of the first phase of renovation, the two-phase renovation can be entered. (4) Identifying pathogenic microorganisms, which can be treated with sensitive drugs, is well prepared for the two-phase renovation, which will be of epoch-making significance for periprosthetic joint infection treatment.  

Key words: joint replacement, periprosthetic infection, alpha-defensin, leukocyte esterase, D-dimer, new nuclear medicine testing methods, metabonomics, proteomics, one-phase renovation, two-phase renovation, National Natural Science Foundation of China

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