| 术中自制临时关节型抗生素骨水泥占位器治疗人工膝关节置换术后感染 |
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投稿时间：2012-10-12
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| 作者 | Author | 单位 | Address | E-Mail |
| 张强 |
ZHANG Qiang |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 周勇刚 |
ZHOU Yong-gang |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 陈继营 |
CHEN Ji-ying |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 刘明 |
LIU Ming |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 张国强 |
ZHANG Guo-qiang |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 柴伟 |
CHAI Wei |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 傅仰木 |
FU Yang-mu |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 王秀丽 |
WANG Xiu-li |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 董晓燕 |
DONG Xiao-yan |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
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| 王岩 |
WANG Yan |
中国人民解放军总医院骨科,北京 100853 |
Department of Orthopaedics,General Hospital of PLA,Beijing 100853,China |
301yanwang@gmail.com |
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| 期刊信息：《中国骨伤》2013年，第26卷，第2期，第119-123页 |
| DOI：10.3969/j.issn.1003-0034.2013.02.009 |
| 基金项目:国家863主题项目资助(编号：2011AA030101) |
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中文摘要:
目的：研究术中自制临时关节型抗生素骨水泥占位器治疗人工膝关节置换术后感染的有效性.
方法：使用自制压模器术中制备临时关节型抗生素骨水泥占位器.自2002年3月至2007年3月共使用此占位器治疗22例膝关节置换术后感染患者,男10例10膝,女12例12膝,平均年龄59.6岁(33～75岁).初次置换到感染症状出现时间间隔平均6.7个月(1～14个月).临床症状,血象、血沉、C-反应蛋白等血液感染指标及膝关节穿刺涂片和培养用以明确假体周围感染,两期手术后均监测感染指标变化,定期随访复查X线片,功能评价使用HSS评分系统.
结果：所有患者获得随访,平均占位器植入间隔时间为4.7个月(3～9个月),Ⅱ期术前感染控制率为100%.Ⅱ期术后平均随访时间29.8个月(10～64个月),无感染复发.Ⅰ期术后膝关节HSS评分由术前的平均40.5±5.9提高到65.8±7.5,Ⅱ期术后最近随访时达平均88.7±5.1.9例对治疗结果满意,12例非常满意.
结论：此方法制备的膝关节临时关节型占位器具有治疗期间保留较好关节功能、降低Ⅱ期手术难度、无须长期灌注及可靠的感染控制力等优点,治疗人工膝关节置换术后感染效果可靠. |
| 【关键词】关节成形术,置换,膝 感染 手术后并发症 |
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| Treatment of infected total knee arthroplasty with a self-made,antibiotic-loaded cement articulating spacer |
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ABSTRACT
Objective:To study the efficacy of self-made,antibiotic-loaded cement articulating spacer in the treatment of infected total knee arthroplasty.
Methods:The self-made molds were used to form the spacer during the operation. From March 2002 to March 2007,22 patients with infected knee arthroplasty (10 males with 10 knees,12 females with 12 knees) were treated with this kind of spacer in our center. The mean age of the patients was 59.6 years old(33 to 75 years old). The interval time between primary arthroplasty and first onset of infective syndrome was 6.7 months(1 to 14 months). The diagnosis was established by the clinical presentation,serum laboratory inflammatory markers (white blood cell count,erythrocyte sedimentation rate and C-reactive protein) and knee aspiration. The serum laboratory inflammatory markers were used to measure the systemic response to infection. Clinical and radiographic follow-up was regularly performed by HSS score system and X-ray.
Results:All the patients were followed,the average interval between debridement and reimplantation was 4.7 months (3 to 9 months) and the infection control rate was 100% after the implantation of spacer. The average follow-up duration after reimplantation was 29.8 months (10 to 64 months) and there was no recurrence of infection at the latest follow-up. The HSS score increased from 40.5±5.9 to 65.8±7.5 after the implantation of spacer,furthermore,the score reached 88.7±5.1 in average at the latest follow-up. The patient satisfaction rate was 95.3%.
Conclusion:This self-made molds and spacers is a reliable approach for the management of infected knee arthroplasty with some virtues,such as providing a mobile and functional joint through the treatment course,decreasing the difficulty of reimplantation,avoiding of a long-term post-operative infusion and high effective for eradicating infection. |
| KEY WORDS Arthroplasty,replacement,knee Infection Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 张强,周勇刚,陈继营,刘明,张国强,柴伟,傅仰木,王秀丽,董晓燕,王岩.术中自制临时关节型抗生素骨水泥占位器治疗人工膝关节置换术后感染[J].中国骨伤,2013,26(2):119~123 |
| 英文格式: | ZHANG Qiang,ZHOU Yong-gang,CHEN Ji-ying,LIU Ming,ZHANG Guo-qiang,CHAI Wei,FU Yang-mu,WANG Xiu-li,DONG Xiao-yan,WANG Yan.Treatment of infected total knee arthroplasty with a self-made,antibiotic-loaded cement articulating spacer[J].zhongguo gu shang / China J Orthop Trauma ,2013,26(2):119~123 |
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