人工膝关节术后感染的诊断和二期翻修术

目的：对人工膝关节(TKA)术后感染接受二次翻修术的膝关节进行评估。方法：1996年1月～2002年1月实行人工膝关节置换术353膝，其中5个膝关节在术后出现感染，行二期翻修术即一期手术取出原假体，彻底清创，置入抗生素骨水泥间隙垫，术后使用6周以上的敏感抗生素，二期手术作假体翻修术。结果：平均随访2年，无1例翻修的膝关节发生感染或无菌性松动。最近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58分(20～100分)，平均膝关节疼痛评分从术前的38分(24～50分)增加到术后的93分(87—100分)。结论：应该尽量采用二期翻修术处理TKA术后感染，以彻底的清除感染灶，使病人获得良好的功能。

Diagnosis of infection after total knee arthroplasty (TKA) and second-stage revision

Objective:To review the results and complication of treatment of infection after total knee arthroplasty(TKA().)Method:Five knees underwent second-stage revision total knee arthroplasty for infection between January 1996 and January 2002.In all patients,a prothesis of antibiotic-loaded acrylic cement was implanted during first stage after debridement.The range of motion of the knee joint was measured.After two years of follow-up,outcomes were assessed with use of the Knee Society Clinical Rating System.Result:No patients required a revision for 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 points before implant to 58 points (range from 20 to 50 points) after reimplantation.The mean Knee Society Pain Score had improved from 38 points (range from 24 to 50 points) to 93 points (range from 87 to 100 points) after reimplantation.Conclusion:Second-stage revision should be taken to treat infection after TKA and clear focus of infection.