感染性人工膝关节翻修术中抗生素的选择

目的:探讨二期翻修术治疗人工膝关节术后感染的抗生素选择原则.方法:1990～2000年本科采用二期翻修术处理11膝人工膝关节术后感染.第1次手术时,彻底清创后膝关节内植入庆大霉素骨水泥间隙垫,之后根据细菌的药物敏感试验结果和医生的经验选择合理的抗生素治疗6周以上(非胃肠道途径).翻修术后平均随访32个月(24～43个月),采用膝关节临床评分系统对这些膝关节进行评估.结果:没有一个翻修的膝关节因为感染或者无菌性松动而接受再次翻修术,所有部件均获得良好固定.最后一次随访时,平均膝关节功能评分从翻修术前的0分增加到术后的63分(20～100分),平均膝关节疼痛评分从术前的42分(24～50分)增加到术后的95分(87～100分).结论:为彻底清除人工膝关节术后感染,临床医生应该尽量明确致病菌,根据药物敏感试验的结果和医生的经验选择有效的抗生素进行系统的治疗,并在膝关节内使用抗生素骨水泥间隙垫.

Antibiotic selection for staged revision of infected total knee

Objective:The purpose of this study was to review the principles of antibiotic selection for staged revision of infected total knee arthroplasty.Method:Eleven patients underwent two-staged revision total knee arthroplasty for infection between 1990 and 2000.In all patients,a gentamicin-loaded acrylic cement spacer was implanted during the first stage after debridement,then sensitive antibiotics based on culture results were given intravenously for at least six weeks.After an average of 32 months of follow-up,outcomes were assessed with use of the Knee Society Clinical Rating System.Result:No patient required a revision because of a recurrence of the infection or aseptic loosening,and all components were well fixed radiographically.At the time of the last follow-up,the mean Knee Society function score had improved from 0 point before implantation to 63 points (range 20 to 50 points)after reimplantation.The mean Knee Society pain score had improved from 42 points (range 24 to 50 points)to 95 points (range 87 to 100 points)after reimplantation.Conclusion:We believe that an antibiotics-impregnated cement spacer should be implanted during the first stage after debridement,and sensitive antibiotics should be given intravenously for at least six weeks.