急性人工关节感染围手术期综合治疗的临床研究

发布时间：2018-04-12 21:15

本文选题：关节置换手术 + 急性人工关节感染　；参考：《福建医科大学》2015年硕士论文

【摘要】：目的急性人工关节感染(APJI)是人工关节置换术后主要的并发症之一,常发生于术后早期或血源播散。对于急性人工关节感染而言,围手术期综合治疗即保留假体清创联合抗生素治疗是其治疗手段之一,且愈早采取措施成功率愈高,约60-80%。本研究旨在探讨APJI采取保留假体清创联合抗生素使用的治疗效果。方法回顾性分析自2011~2014年我院收治14例采取保留假体联合抗生素治疗的人工关节置换术后急性人工关节感染的病例,其中髋关节置换术后感染6例(失访1例,实际随访5例),膝关节术后感染8例。保留假体的关节清创术前常规检查C反应蛋白,降钙素原(PCT),所有病例术前均行关节穿刺细菌培养,术中常规行关节液常规与细菌培养。髋关节清理时应脱出股骨头后彻底清理关节内炎性病灶。膝关节清理时应取出聚乙烯衬垫,彻底清除关节囊内可疑感染病灶,更换新的聚乙烯衬垫。常规留置引流管,并关节腔内局部抗生素治疗。所有保留假体清创病例术后均采用相对应的敏感抗生素治疗3个月,并定期随访CRP指标、血沉(ESR)及关节功能情况。结果?本组13例采取保留假体的急性人工关节感染中,平均随访:20.69月(9.15-35.45月),其中9例成功保留假体,平均随访时间17.33月(7.50-36.35月),感染无复发,4例保留假体失败(膝关节3例,1例髋关节);平均随访时间28.25月(5.33-50.00月);保留假体成功率为69.2%。?9例治疗成功的患者从出现症状到清创平均时间间隔14.44d(9.00-20.67d);4例治疗失败的患者从出现症状到清创平均时间间隔7.5d(4-10d),两组清创时间间隔经t检验分析,无统计学意义,及两组清创间隔时间无差异(t=1.449,P0.005)?13例急性人工关节感染术前或术中细菌培养结果显示:9例为葡萄球菌属感染,占69.2%,其中金黄色葡萄球菌感染2例,耐甲氧西林金黄色葡萄球菌1例,表皮葡萄球菌4例(包括耐甲氧西林表皮葡萄球菌3例),头状葡萄球菌1例,溶血葡萄球菌1例;其余病原体中大肠埃希菌3例,占27.3%;最后1例为粪肠球菌。结论保留假体清创对于急性人工关节感染中有一定价值,成功率为69.2%,应充分把握时机和适应证。
[Abstract]:Objective acute prosthetic joint infection (APJI) after artificial joint replacement is one of the main complications, often occurs in the early postoperative period or hematogenous spread. For acute prosthetic joint infection, perioperative comprehensive preserving prosthesis debridement combined with antibiotic therapy is the treatment of one of the means, and the success rate of the early measures about 60-80%., this study aimed to investigate the therapeutic effect of APJI by debridement and component retention combined with antibiotic use. Methods a retrospective analysis from 2011~2014 in our hospital 14 cases of acute infection of artificial joints adopt artificial joint replacement prosthesis retention combined with antibiotics in the treatment of the cases, the hip arthroplasty infection in 6 cases (lost in 1 cases, 5 cases were followed up), 8 cases of knee joint prosthesis retention. Postoperative infection after joint debridement routine examination before C reactive protein, procalcitonin (PCT), all patients underwent preoperative joint puncture Bacterial culture, routine operation in joint fluid routine and bacterial culture. We should thoroughly clean after removing femoral head intra-articular inflammatory lesion of hip cleaning. Knee joint cleaning should remove the polyethylene liner, completely remove the intraarticular suspected infection lesions, polyethylene liner exchange new. The conventional indwelling drainage tube, and joint cavity the local antibiotic therapy. All cases of postoperative debridement and component retention using sensitive antibiotic corresponding treatment for 3 months, and regular follow-up CRP index, erythrocyte sedimentation rate (ESR) and joint function. Results? 13 cases of this group take prosthesis retention acute artificial joint infection, mean follow-up of 20.69 months (9.15-35.45 months:), including 9 cases of successful retention of the prosthesis, the average follow-up time of 17.33 months (7.50-36.35 months), no recurrence of infection, 4 cases of retained prosthesis failure (3 cases, 1 cases of knee joint and hip joint); the average follow-up time of 28.25 months (5.33-50.00 months); retention of the prosthesis into The power is 69.2%.? 9 cases of successful treatment of patients suffering from symptoms to debridement and average time interval 14.44d (9.00-20.67d); 4 cases of treatment failure patients from onset of symptoms to debridement and average time interval 7.5d (4-10d), two groups of debridement time interval by t test analysis, no statistical significance, and two groups of Qing Dynasty a time interval difference (t=1.449, P0.005)? Preoperative bacterial culture results showed that 13 cases of acute prosthetic joint infection: 9 cases of Staphylococcus infection, accounted for 69.2%, of which 2 cases of infection of Staphylococcus aureus, methicillin resistant Staphylococcus aureus in 1 cases, 4 cases of Staphylococcus epidermidis (including methicillin-resistant Staphylococcus epidermidis in 3 cases), 1 cases of Staphylococcus capitis, 1 cases of hemolytic Staphylococcus; Escherichia coli and other pathogens in 3 cases, accounting for 27.3%; the last 1 were Enterococcus faecalis. Conclusion debridement and component retention for a certain value of acute prosthetic joint infection, success The rate is 69.2%, and the timing and indications should be fully grasped.

【学位授予单位】：福建医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4

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