清创保留假体联合抗生素治疗膝关节置换术后急性感染

目的探讨采用清创保留假体联合抗生素(DAIR)治疗人工膝关节置换术后急性期感染的临床疗效。 方法回顾性分析解放军联勤保障部队第九四〇医院关节外科自2008年12月1日至2018年11月30日收治的，根据美国肌肉与感染协会(MSIS)诊断标准确诊为急性人工关节感染(PJI)的26例膝关节置换术后急性感染患者的临床资料。所有患者均采用一期彻底清创，更换膝关节聚乙烯衬垫，术后膝关节腔持续冲洗引流及足疗程敏感抗生素治疗。用t检验比较患膝术前、术后的膝关节疼痛视觉模拟评分(VAS评分)，美国特种外科医院膝关节评分(HSS评分)，入院及末次随访红细胞沉降率(ESR)、C反应蛋白(CRP)、白细胞介素-6(IL-6)。 结果纳入26例患者，失访3例，随访时间平均(44±28)个月。其中治愈17例，感染控制率73.9%。术后的膝关节VAS评分较术前降低(t＝24.815，P<0.05)，术后的HSS评分较术前升高(t＝41.966，P<0.05)。末次随访ESR(t＝14.140)、CRP(t＝3.503)、IL-6(t＝2.999)均较入院时降低(均为P<0.05)。 结论DAIR治疗人工膝关节置换术后急性感染，严格把握手术时机及手术适应证，可有效控制感染，恢复关节功能，临床效果满意。

Debridement and implant retention combining antibiotics in treatment of acute infection following total knee arthroplasty

ObjectiveTo evaluate the clinical efficacy of debridement, antibiotics, and implant retention (DAIR) in the treatment of acute infection after total knee arthroplasty. MethodsA retrospective analysis of the joint surgery of the 940th Hospital of the Joint Service Support Force of the Chinese People's Liberation Army from December 1, 2008 to November 30, 2018, was diagnosed with acute prosthetic joint infection (PJI) cases according to the diagnostic criteria of the American Society for Musculoskeletal Infection (MSIS), a total of 26 clinical data of patients with infection after acute knee arthroplasty. All the patients were treated with one-stage thorough debridement, replacement of knee joint polyethylene pads, postoperative wound irrigation and drainage, and adequate treatment with sensitive antibiotics. The pain visual analogue scale (VAS), Hospital for Special Surgery (HSS) score of the knee, sedimentation rate (ESR), C-reactive protein (CRP), interleukin (IL) -6 before and after the knee surgery were compared by t test. ResultsTwenty-six patients were enrolled, three cases were lost during the follow-up, and the follow-up time was (44±28) months. Among them, 17 cases were cured, the infection control rate was 73.9%.The postoperative knee joint VAS score was lower than that before surgery (t=24.815, P<0.05), and the postoperative HSS score was higher than that before surgery (t=41.966, P<0.05). ESR(t=14.140), CRP(t=3.503), and IL-6 (t=2.999)at last follow-up were all lower than those at admission (all P<0.05). ConclusionControlling the timing of surgery and the indications for surgery strictly, DAIR can control the acute infections after total knee arthroplasty effectively, restore joint function, and obtain satisfactory clinical results.