一种新型间隔器技术在膝关节置换术后感染二期翻修中的应用

目的探讨一种新型间隔器制作方法在全膝关节置换术（TKA）后假体周围感染治疗方面的可行性和有效性。方法本研究纳入2009年7月至2012年1月间收入院的6例TKA术后慢性深部感染患者，采用二期翻修手术治疗第一阶段彻底清创后使用消毒后的股骨假体、新内衬和抗生素骨水泥作为关节间隔器，确认感染控制后行第二阶段膝关节翻修手术。术后观察感染控制情况和关节功能恢复情况。结果共5例患者按计划接受新型间隔器的二期翻修术。平均随访时间（24．4±10．5）个月（8—37个月）；术前、间隔器安置后、二期翻修后平均HSS评分分别为（40±5．3）分（32-46分），（47±2．6）分（43～50分），（65．4±2．3）分（62～68分）。术前、间隔器安置后、二期翻修后平均关节活动度分别为（75°±3．5°）（70°-80°），（94°±4．2°）（90°～100°），（106。±4．20）（100°-110°）。总体感染消除率为83．3％。结论消毒后假体和抗生素骨水泥组成的间隔器在治疗TKA术后假体周围感染上有优良的临床前景。

Two-stage revision with new spacer technique in treatment of periprosthetic infection after total knee arthroplasty

Objective To explore the feasibility and effectiveness of a new spacer technique for the treatment of periprosthetic infection after total knee arthroplasty. Methods Six patients with periprosthetic infection after total knee arthroplasty from July 2009 to January 2010 were included in this study, and they received two-stage revision surgery after admission. The spacer used after debridement was made of original femoral component after disinfection, new liner and antibiotic-loaded cement. Reimplantation was performed after eradication of infection. The management of infection and function of knee joint were recorded in the follow-up. Results Five patients received two-stage revision with new spacer technique. The mean follow-up time was 24. 4 months. The HSS scores before revision, after implantation of spacer and at last follow-up after revision were 40, 47 and 65.4, respectively. The ranges of motion of involved knee before revision, after implantation of spacer and at last follow-up after revision were 75°, 94° and 106°, respectively. The success rate in terms of infection eradication was 83.3%. Conclusions Spacer made of original femoral component after disinfection, new liner and antibiotic-loaded cement may play an effective role in the two-stage revision for the treatment of periprosthetic infection after total knee arthroplasty.