人工髋膝关节置换术后假体周围慢性感染病原菌培养方法及结果分析

发布时间：2018-06-25 23:37

  本文选题：关节成形术 + 感染　； 参考：《新疆医科大学》2015年硕士论文

【摘要】：目的：报告人工髋、膝关节置换术后假体周围慢性感染病原菌培养方法,分析培养结果。方法：回顾性分析自2010年9月至2014年3月收治的全膝关节置换术(total knee arthroplasty TKA)及全髋关节置换术(total hip arthroplasty THA)术后被明确诊断为假体周围慢性感染的患者23例。其中TKA 15例,THA8例；男12例,女11例；年龄32-79岁,平均62岁；伴有窦道患者9例。患者均在关节腔穿刺前至少2周停用抗生素治疗,翻修术前及术中分别取关节液予以病原菌培养及药敏试验。术中组织行一般病原菌培养及病理活检,培养结果为阴性的样本延长至2周。结果：本组患者共23例,术前培养1周阳性率30.4%(7/23),阴性样本延长至两周阳性率39.1%(9/23)。分析原因可能与所取关节液量不足,穿刺中抑菌成分带入,培养时间不足等因素有关。术中培养1周阳性率60.9%(14/23),阴性样本延长至两周阳性率82.6%(19/23),7例(30.4%)术前及术中培养结果相符。结论：对人工髋、膝关节置换术后假体周围慢性感染行病原菌培养,在明确诊断前停用抗生素至少2周,严格无菌的标本处理,合理延长培养时间,与微生物室紧密协作,能明显提高病原菌培养的阳性率,合理指导临床针对性使用抗生素,提高翻修术后感染控制率。
[Abstract]:Objective: to report the culture method of pathogenic bacteria of chronic infection around prosthesis after hip and knee arthroplasty, and to analyze the results of culture. Methods: from September 2010 to March 2014, 23 patients with chronic periprosthetic infection were analyzed retrospectively after total knee arthroplasty (total knee arthroplasty tha) and total hip arthroplasty (total hip arthroplasty tha). There were 15 cases of TKA with THA, including 12 males and 11 females, aged 32-79 years (mean 62 years), and 9 patients with sinus tract. All the patients stopped antibiotic therapy at least 2 weeks before articular cavity puncture. The synovial fluid was collected before revision and intraoperative respectively for pathogen culture and drug sensitivity test. Tissue culture and pathological biopsy were performed during the operation, and the negative samples were prolonged to 2 weeks. Results: the positive rate was 30.4% (7 / 23) in 1 week before operation, and 39.1% (9 / 23) in negative samples. The analysis may be related to the insufficient amount of joint fluid taken, the introduction of bacteriostasis in puncture, and the shortage of culture time. The positive rate of 1 week culture was 60.9% (14 / 23), and the positive rate of negative samples was 82.6% (19 / 23). Conclusion: the pathogens of chronic infection around prosthesis after hip and knee arthroplasty were cultured, antibiotics were stopped for at least 2 weeks before diagnosis, strict sterile specimen treatment, reasonable extension of culture time, and close cooperation with microorganism room. It can obviously improve the positive rate of pathogen culture, reasonably guide the clinical use of antibiotics, and improve the infection control rate after revision operation.
【学位授予单位】：新疆医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R687.4
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本文编号：2068033