两种spacer在二期翻修治疗TKA术后假体周围感染的应用

发布时间：2018-07-04 07:14

  本文选题：spacer + 假体周围感染　； 参考：《山东大学》2016年硕士论文

【摘要】：目的探讨两种spacer在二期翻修治疗TKA术后假体周围感染患者的临床效果,并比较二者疗效。方法回顾我院自2011年1月至2015年9月因TKA术后假体周围感染接受二期翻修手术治疗的患者20例,其中男13例,女7例；年龄56-77岁,平均64.6岁。TKA术后感染患者在二期翻修手术治疗Ⅰ期手术彻底清创后,其中8例TKA术后患者,选择应用再次消毒后的原股骨假体、对应型号的新聚乙烯垫片和加载敏感抗生素的骨水泥作为spacer;12例TKA术后患者,选择应用经典的骨水泥spacer,并且所有患者膝关节内均加入万古霉素自固化磷酸钙颗粒抗感染治疗,确认感染控制后行Ⅱ期膝关节翻修手术。术后观察感染控制情况和关节功能恢复情况。结果使用再次消毒的原股骨假体为spacer(关节型)的患者(Ⅰ组,n=8)与使用经典骨水泥spacer的患者(Ⅱ组,n=12)进行比较,随访时间6-48个月,平均27个月,结果显示二期翻修Ⅰ期手术spacer放置后Ⅰ组有更好的关节活动度(85±12)°vs(35±20)。,P0.001,KSS评分[65(0～79)vs22(1～57),P=0.026]也更高；同样二期翻修Ⅱ期手术后Ⅰ组也有更好的关节活动度(106±16)°vs(89±18)。,P0.001),KSS评分[90(20～95)vs83(15～89),P=0.015]也更高。两组20例患者复发感染仅有1例(感染控制率为95%),而两组间的感染复发率无统计学差异。结论再次消毒后的原股骨假体、对应型号的新聚乙烯垫片和抗生素骨水泥组成的spacer在治疗TKA术后假体周围感染患者上可以带来更好的运动范围和功能,有更好的临床前景。
[Abstract]:Objective to investigate the clinical effect of two kinds of spacer in the treatment of periprosthetic infection after TKA, and to compare their efficacy. Methods from January 2011 to September 2015, 20 patients (13 males and 7 females) who underwent secondary revision surgery due to periprosthetic infection after TKA were reviewed. An average of 64.6 years old patients with infection after operation of TKA were treated with primary stage I operation complete debridement after second-stage revision surgery. Among them, 8 cases of TKA patients were selected to use proto-femur prosthesis after re-disinfection. The corresponding new polyethylene gasket and bone cement loaded with sensitive antibiotics were used as spacer in 12 patients after TKA operation. The classic bone cement spacer was used in all patients, and vancomycin self-solidified calcium phosphate granules were added to the knee joint for anti-infection therapy. Stage 鈪，

本文编号：2095260