| 抗生素洗脱可吸收硫酸钙在Ⅰ期翻修治疗膝关节假体周围感染中的作用 |
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Received:December 24, 2024
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| 作者 | Author | 单位 | Unit | E-Mail |
| 陈晓波 |
CHEN Xiao-bo |
河南省洛阳正骨医院 河南省骨科医院, 河南 郑州 450000 |
Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopaedic Hospiotal, Zhengzhou 450000, Henan, China |
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| 李帅垒 |
LI Shuai-lei |
河南省洛阳正骨医院 河南省骨科医院, 河南 郑州 450000 |
Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopaedic Hospiotal, Zhengzhou 450000, Henan, China |
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| 刘爱斌 |
LIU Ai-bin |
河南省洛阳正骨医院 河南省骨科医院, 河南 郑州 450000 |
Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopaedic Hospiotal, Zhengzhou 450000, Henan, China |
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| 柴昊 |
CHAI Hao |
河南省洛阳正骨医院 河南省骨科医院, 河南 郑州 450000 |
Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopaedic Hospiotal, Zhengzhou 450000, Henan, China |
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| 孙永强 |
SUN Yong-qiang |
河南省洛阳正骨医院 河南省骨科医院, 河南 郑州 450000 |
Luoyang Orthopedic-Traumatological Hospital of Henan Province, Henan Provincial Orthopaedic Hospiotal, Zhengzhou 450000, Henan, China |
joint99@126.com |
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| 期刊信息：《中国骨伤》2025年38卷，第6期，第580-586页 |
| DOI：10.12200/j.issn.1003-0034.20240310 |
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目的：探讨抗生素洗脱可吸收硫酸钙在Ⅰ期翻修治疗膝关节置换术后假体周围感染(prosthetic joint in-fection,PJI)中的作用。
方法：回顾性分析2018年1月至2022年3月收治的全膝关节置换术后PJI行Ⅰ期翻修的患者36例36膝,所有患者术前经膝关节腔穿刺且无菌体液培养结果阳性,21例术中应用Ⅰ期翻修结合载抗生素硫酸钙(硫酸钙组),15例常规行Ⅰ期翻修(翻修组)。硫酸钙组男9例,女12例;年龄54~76(67.6±6.2)岁。翻修组15例,男4例,女11例;年龄60~75(69.6±4.1)岁。比较两组术后7、14、30、90 d的血清C反应蛋白(C-reactive protein,CRP),术后7、14、30 d白细胞介素-6(interleukin 6,IL-6)水平变化情况,以及末次随访的感染控制率。观察两组全身抗生素应用时长、住院时间及术后并发症情况。
结果：两组患者均获得随访,硫酸钙组随访时间12~29(18.9±4.2)个月,感染控制率90.5%;翻修组随访时间18~29(21.6±3.7)个月,感染控制率86.7%(13/15)。两组随访时间、感染控制率比较,差异无统计学意义(P>0.05)。硫酸钙组术后7、14、30 d的CRP及术后30 d的IL-6分别为(32.79±11.48)、(15.50±6.52)、(9.36±3.32) mg·L-1及(17.31±6.15) pg·ml-1,低于翻修组的(40.65±11.32)、(30.15±10.57)、(18.97±5.86) mg·L-1及(25.54±6.73) pg·ml-1,差异有统计学意义(P<0.05);两组术后7、14 d的IL-6及术后90 d的CRP比较,差异均无统计学意义(P>0.05)。硫酸钙组住院时间、全身抗生素应用时长分别为(18.4±2.2)、(63.5±21.4) d,优于翻修组的(20.5±2.4)、(82.7±16.9) d,差异有统计学意义(P<0.05)。硫酸钙组术后未观察到明显伤口并发症及高钙血症。
结论：抗生素洗脱可吸收硫酸钙可用于治疗膝关节PJI,在术后早期可显著降低CRP水平,缩短住院时间及全身抗生素应用时间,但并未显著提高Ⅰ期翻修感染的控制率。 |
| [关键词]:假体周围感染 膝关节 硫酸钙 翻修术 病例对照研究 |
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| Role of antibiotic eluting absorbable calcium sulfate in phaseⅠrevision treatment of periprosthetic knee infection |
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Abstract:
Objective To explore the role of antibiotic-eluting absorbable calcium sulfate in treating periprosthetic infection after one stage revision of knee arthroplasty.
Methods A retrospective analysis was performed on 36 patients (36 knees) who underwent phaseⅠrevision for periprosthesis infection after total knee arthroplasty from January 2018 to March 2022. All patients were underwent knee cavity puncture before operation and had positive results of aseptic body fluid culture,21 patients received revision combined with antibiotic loaded calcium sulfate at stageⅠ (calcium sulfate group) during operation, and 15 patients underwent renovation at stageⅠ(revision group). There were 9 males and 12 females in calcium sulfate group, aged from 54 to 76 years old with an average of (67.6±6.2) years old. There were 15 patients in revision group,including 4 males and 11 females,aged from 60 to 75 years old with average of (69.6±4.1) years old. The levels of serum C-reactive protein (CRP),interleukin-6 (IL-6) at 7,14,30 and 90 days after operation were compared between two groups,and the rate of end infection control at follow up were compared. The systemic antibiotic application time,hospital stay and postoperative complications were observed between two groups.
Results Calcium sulfate group were followed up for 12 to 29 months with an average of(18.9±4.2) months,and the infection control rate was 90.5%;while revision group were followed up 18 to 29 months with average of (21.6±3.7) months,and the infection control rate was 86.7% (13/15). There were no significant differences in follow up time and infection control rate between two groups(P>0.05). Postoperative levels of CRP and IL-6 at 7,14 and 30 days in calcium sulfate group were (32.79±11.48),(15.50±6.52),(9.36±3.32) mg·L-1 and (17.31±6.15) pg·ml-1,respectively; which were lower than those in revision group (40.65±11.32),(30.15±10.57),(18.97±5.86) mg·L-1 and (25.54±6.73) pg·ml-1,had statistical differences (P<0.05). There were no significant differences in IL-6 levels at 7 and 14 days after operation and CRP levels at 90 days after operation between two groups (P>0.05). The hospitalization time and systemic antibiotic application time in calcium sulfate group were (18.4±2.2) and (63.5±21.4) d,respectively;which were better than those in revision group (20.5±2.4) and (82.7±16.9) d,and had statistical differences(P<0.05). No significant wound complications and hypercalcemia were observed in calcium sulfate group.
Conclusion Antibiotic eluted absorbable calcium sulfate could be used to treat periprosthetic knee infection,significantly reducing CRP levels in the early postoperative period,shortening hospital stay and systemic antibiotic application time,but it does not significantly improve the control rate of revision infection at stageⅠ. |
| KEYWORDS:Periprosthetic infection Knee joint Calcium sulfate Revision Case-control study |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 陈晓波,李帅垒,刘爱斌,柴昊,孙永强.抗生素洗脱可吸收硫酸钙在Ⅰ期翻修治疗膝关节假体周围感染中的作用[J].中国骨伤,2025,38(6):580~586 |
| 英文格式: | CHEN Xiao-bo,LI Shuai-lei,LIU Ai-bin,CHAI Hao,SUN Yong-qiang.Role of antibiotic eluting absorbable calcium sulfate in phaseⅠrevision treatment of periprosthetic knee infection[J].zhongguo gu shang / China J Orthop Trauma ,2025,38(6):580~586 |
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