Vacuum sealing drainage combined with iodophor douche for the prosthesis infection after artificial joint replacement

doi:10.3969/j.issn.2095-4344.2016.44.002

Abstract

Abstract:

BACKGROUND: Periprosthetic infection after artificial joint replacement is a disastrous complication for a patient. Currently, during treating for the periprosthetic infection, most of patients need two-stage revision, which bring about enormous physical and psychological pain for patients, and a heavy burden for the families and society. To make matters worse, the effect is not very perfect, and some of these cases require multi-stage revision, even amputation.

OBJECTIVE: To investigate the therapeutic effect of vacuum sealing drainage combined with iodophor douche for the infection after artificial joint replacement.

METHODS: Nine cases (six knees and three hips) of infection after artificial joint replacement were collected, with an average age of 63.4 years. Infection occurred at 7 days-14 months, and a median time of 1 month after replacement. All patients suffered from purulent or purulent blood secretion. Fistula formed in two cases and incision and drainage sites were not healed in one case. According to the bacterial culture results, above symptoms were accorded with clinical diagnosis of prosthesis infection. The prosthesis was remained for debridement. Vacuum sealing drainage was performed. Iodophor douche (30-50 mL) was conducted every day. The drainage tube at proximal end was occluded for 30 minutes, and then vacuum sealing drainage was performed. All patients were regularly followed up to assess the therapeutic effects of vacuum sealing drainage combined with prosthesis infection after replacement.

RESULTS AND CONCLUSION: (1) Except that one case was still in treatment, one case was dead, and one case of tumor prosthesis was failure and finally amputated, the remaining six patients were healed. (2) The time of vacuum sealing drainage and iodophor douche was 10 to 84 days, with the median time of 57 days. No adverse reactions or complications occurred. All healed patients were followed up for 12-60 months, without recurrence. (3) These results indicated that vacuum sealing drainage combined with iodophor douche retained the prosthesis to the greatest degree, is simple, safe, and effective for the infection after artificial joint replacement, needs a low cost, and is a kind of therapy for prosthesis infection after artificial joint replacement.

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: Negative-Pressure Wound Therapy, Drainage , Disinfection , Arthroplasty , Replacement , Prosthesis Implantation, Tissue Engineering

CLC Number:

R318

Zhang Yang-chun, Xiao Jian-hong, Zhang Zi-ji, Yang Xing, Yu Shi-ming, Sheng Pu-yi . Vacuum sealing drainage combined with iodophor douche for the prosthesis infection after artificial joint replacement[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(44): 6549-6556.

Figures/Tables 3

2.2 患者治疗相关数据假体感染患者手术清创均顺利完成，术后负压引流通畅，应用负压引流期限14-88 d，平均为50.4 d；减除伤口冲洗液，术后3 d负压吸引量210-295 mL/d，平均(228.5±32.7) mL/d，3 d后伤口引流量逐渐减少，大多不超过20 mL。碘伏灌洗时间10-84 d，平均47 d，之后负压引流管引出少量清亮液体，伤口愈合良好，细菌培养阴性，确定无感染迹象后停止碘伏灌洗。 2.3 不良反应患者中未发现对碘伏严重过敏者，有4例在最初3-5 d碘伏灌洗时，都在局部逐渐出现了轻度的发热、红和烧灼感，约2 h后，上述不良反应可逐渐消失，在关节局部行灌洗时患侧肢体的感觉、运动及神经反射无明显影响，患者精神、睡眠、饮食、性格正常，无眼部刺激症状以及口咽部刺激感，没有发现全身不良反应例如胸闷、心悸、头疼头晕等不适，所有患者治疗前、治疗后的心电图、肝肾功能、血常规、胸透、尿便常规化验均没有发现明显改变。 2.4 结果数据统计术后2周，静脉血白细胞、C-反应蛋白和血沉较术前显著下降(P均< 0.05)，见表1。复查肝肾功能，各项指标也基本正常，术后1周及2周与术前比较差异均无显著性意义(P均> 0.05)，见表2。平均静脉抗生素用药为18 d，平均口服抗生素用药45 d，平均住院日62 d。 1例结核患者混合金黄色葡萄球菌感染，负压引流及碘伏灌洗40 d仍未治愈，同时联合抗结核治疗，要求返回当地医院继续负压引流及碘伏灌洗治疗，目前仍在当地住院治疗，但出院前本院及当地医院细菌培养，金黄色葡萄球菌阴性，渗出较前明显减少，局部无红肿热痛。1例老年男性患者因原发心功能不全及肾衰，治疗30 d因内科疾病加重，出现肺水肿，转内科治疗，最后因多器官功能不全死亡。1例患胫骨上端骨肉瘤行全膝关节置换肿瘤型膝关节假体置换后第7天，引流口仍持续有淡红色液体渗出，取渗出物培养2次为金黄色葡萄球菌感染，术后第14天予以积极清创，术后负压引流及碘伏灌洗73 d，感染仍控制欠佳，胫骨端有骨坏死，最后予以大腿中段截肢，并定期放化疗。其余6例患者均顺利治愈。6例患者负压引流术联合碘伏灌洗为10-84 d，中位时间是57 d，治疗过程中无并发症及不良反应发生，创面愈合良好，关节疼痛缓解，关节功能恢复；髋关节屈曲 96°-130°，平均 117.2°，伸直> 0°，内、外旋均为25°-36°，平均28.9°；膝关节伸直-10°-0°，平均-4.5°，屈曲80°-110°，平均95.1°。治愈患者均获随访，随访时间12-60个月，无复发病例。"

References

[1] 白云鹤,吴若丹,卢斌,等. 保留假体持续灌洗治疗人工全膝关节置换术后严重感染的疗效观察[J]. 中国药物经济学,2015,(2):116-118.
[2] 叶一林,柴卫兵,李军,等. 保留假体的关节清创术结合术后持续灌洗治疗人工关节置换术后急性假体周围感染[J]. 中国矫形外科杂志,2011,19(13):1057-1060.
[3] Deirmengian C, Kardos K, Kilmartin P, et al. Diagnosing periprosthetic joint infection: has the era of the biomarker arrived? Clin Orthop Relat Res. 2014; 472(11):3254-3262.
[4] 吴同申,孟娟,张磊,等.碘附灌洗治疗慢性骨髓炎的效果[J].齐鲁医学杂志,2004,19(5):418-419.
[5] Phillips CB, Barrett JA, Losina E, et al. Incidence rates of dislocation, pulmonary embolism, and deep infection during the first six months after elective total hip replacement. J Bone Joint Surg Am. 2003;85-A(1): 20-26.
[6] Hyman JL, Salvati EA, Laurencin CT, et al. The arthroscopic drainge, irrigation and debridement of late, acllte total hip arthroplasty infections. J Arthroplasty. 2003;14(903):E23.
[7] Lindeque B, Hartman Z, Noshchenko A, et al. Infection after primary total hip arthroplasty. Orthopedics. 2014; 37(4):257-265.
[8] George DA, Khan M, Haddad FS. Periprosthetic joint infection in total hip arthroplasty: prevention and management. Br J Hosp Med (Lond). 2015;76(1): 12-17.
[9] 王常德,康鹏德,裴福兴,等.全关节置换术后假体周围感染诊断的研究进展[J].中国矫形外科杂志,2016,24(10): 907-910.
[10] 裘华德,宋九宏.负压封闭引流技术[M]. 2版. 北京:人民卫生出版社,2008.
[11] 杨桂元,钱祝银. 负压封闭引流技术研究进展[J]. 中国实用外科杂志,2010,30(2):149-151.
[12] 余世明,张阳春,胡俊勇,等.负压封闭引流联合聚维酮碘灌洗治疗慢性骨髓炎[J].中国骨与关节外科,2011,4(6): 467-472.
[13] Fleischmann W, Lang E, Russ M. [Treatment of infection by vacuum sealing]. Unfallchirurg. 1997; 100(4):301-304.
[14] Webb LX. New techniques in wound management: vacuum-assisted wound closure. J Am Acad Orthop Surg. 2002;10(5):303-311.
[15] Labler L, Trentz O. The use of vacuum assisted closure (VAC) in soft tissue injuries after high energy pelvic trauma. Langenbecks Arch Surg. 2007;392(5):601-609.
[16] 李靖,陈绍宗,李学拥. 封闭负压引流对创面微循环超微结构影响的实验研究[J]. 中国实用美容整形外科杂志, 2006,17(1):1848-1849.
[17] Wild T, Stremitzer S, Budzanowski A, et al. Definition of efficiency in vacuum therapy--a randomised controlled trial comparing with V.A.C. Therapy. Int Wound J. 2008; 5(5):641-647.
[18] Herscovici DJ, Sanders RW, Scaduto JM, et al. Vacuum-assisted wound closure (VAC therapy) for the management of patients with high-energy soft tissue injuries. J Orthop Trauma. 2003;17(10):683-688.
[19] 姚元章,黄显凯,麻晓林.负压封闭引流技术治疗创伤后软组织缺损[J].创伤外科杂志,2002,4(1):9-12.
[20] 辛忠,楼文军,吴起新,等. 固体碘伏杀菌效果及影响因素的观察[J].中国消毒学杂志,1992,9(2):84-87.
[21] 刘树民,王春玲.碘伏持续灌注冲洗治疗慢性骨髓炎68例报告[J]. 实用骨科杂志,2007,13(9):566-573.
[22] 蔡长春,李景苏,侯艳宁. 骨与关节感染性疾病临床抗菌药物选择应用[J]. 中国药师,2003,6(4):236-238.
[23] 唐延军,刘建锋,王宪俊,等. 负压封闭引流技术_万古霉素珠链填充治疗慢性创伤性骨髓炎[J]. 中国临床研究, 2010, 23(1):42-43.
[24] 袁壁君.抗生素对革兰阳性菌骨和关节感染的治疗[Z]. 2005: 24-27.