负压封闭引流结合敏感抗生素治疗假体周围急性感染
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作者Author单位AddressE-Mail
史文骥 SHI Wen-ji 宁波市第一医院 浙江大学宁波医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China shi97529@sina.com 
毛宾尧 MAO Bin-yao 宁波市第一医院 浙江大学宁波医院骨科, 浙江 宁波 315010 Department of Orthopaedics, the First Hospital of Ningbo, Ningbo 315010, Zhejiang, China  
施靖宇 SHI Jing-yu 宁波大学医学院, 浙江 宁波 315000  
期刊信息:《中国骨伤》2020年,第33卷,第6期,第566-571页
DOI:10.12200/j.issn.1003-0034.2020.06.016
基金项目:
中文摘要:

目的:探讨负压封闭引流(vacuum sealing drainage,VSD)结合敏感抗生素治疗假体周围急性感染的疗效。

方法:回顾性分析2012年3月至2018年12月采用保留假体的清创、VSD、敏感抗生素治疗11例假体周围急性感染,男7例,女4例;年龄58~88岁,平均72.5岁。髋关节假体周围感染8例,3例出现窦道,膝关节假体周围感染3例。

结果:微生物培养阴性2例,阳性9例,金黄色葡萄球菌7例,其中2例耐甲氧西林金黄色葡萄球菌(methicillin-resistant staphylococcus aureus,MRSA),表皮葡萄球菌2例。术后随访8~52个月,平均28个月,1例髋关节假体周围感染清创失败,清创距关节置换时间84 d,行II期人工关节翻修术。10例清创成功。末次随访时,髋关节假体周围感染清创成功患者Harris评分84.1(74~93)分;膝关节假体周围感染者膝关节协会评分(Knee Society score,KSS)84,84,89分。

结论:膝关节置换术后1个月内,髋关节置换术后6周内假体周围急性感染,及服用抗凝药物引起假体周围出血伴急性感染,采用保留假体的清创,VSD及敏感抗生素治疗,可获得较满意的效果。
【关键词】假体相关感染  引流术  清创术
 
Treatment of acute infection around prosthesis with vacuum sealing drainage and sensitive antibiotics
ABSTRACT  

Objective: To investigate the therapeutic effects of vacuum sealing drainage(VSD) combined with antibiotics in treating acute periprosthetic joint infection(PJI).

Methods: From March 2012 to December 2018,there were 11 patients with acute PJI underwent debridement,VSD,antibiotics and retention of implant,including 7 males and 4 females,with an average age of 72.5 years old(ranged,58 to 88 years old). There were 8 hips and 3 knees. Three patients had sinus tract.

Results: There were 2 patients with negative culture result and 9 patients with positive culture result,including 5 cases of methicillin-sensitive staphylococcus aureus,2 cases of methicillin-resistant staphylococcus aureus(MRSA),2 cases of staphylococcus epidermidis. The mean follow-up duration was 28 months(ranged from 8 to 52 months). One case of infection around hip prosthesis failed to be debrided. The time of debridement and replacement of the calcar joint was 84 days. Debridement was successful in 10 cases. At the latest follow-up,Harris score of patients with successful debridement of hip periprosthetic infection ranged from 74 to 93,with an average score of 84.1;Knee Society scores of patients with periprosthetic infection were 84,84,89.

Conclusion: For acute infection around the prosthesis within 1 month after knee replacement and 6 weeks after hip replacement,and for bleeding around the prosthesis with acute infection caused by anticoagulant drugs,satisfactory results can be obtained by debridement,VSD and sensitive antibiotics
KEY WORDS  Prosthesis-related infection  Drainage  Debridement
 
引用本文,请按以下格式著录参考文献:
中文格式:史文骥,毛宾尧,施靖宇.负压封闭引流结合敏感抗生素治疗假体周围急性感染[J].中国骨伤,2020,33(6):566~571
英文格式:SHI Wen-ji,MAO Bin-yao,SHI Jing-yu.Treatment of acute infection around prosthesis with vacuum sealing drainage and sensitive antibiotics[J].zhongguo gu shang / China J Orthop Trauma ,2020,33(6):566~571
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