發(fā)布時間：2018-04-12 21:15

  本文選題：關(guān)節(jié)置換手術(shù) + 急性人工關(guān)節(jié)感染��； 參考：《福建醫(yī)科大學》2015年碩士論文

【摘要】：目的急性人工關(guān)節(jié)感染(APJI)是人工關(guān)節(jié)置換術(shù)后主要的并發(fā)癥之一,常發(fā)生于術(shù)后早期或血源播散。對于急性人工關(guān)節(jié)感染而言,圍手術(shù)期綜合治療即保留假體清創(chuàng)聯(lián)合抗生素治療是其治療手段之一,且愈早采取措施成功率愈高,約60-80%。本研究旨在探討APJI采取保留假體清創(chuàng)聯(lián)合抗生素使用的治療效果。方法回顧性分析自2011~2014年我院收治14例采取保留假體聯(lián)合抗生素治療的人工關(guān)節(jié)置換術(shù)后急性人工關(guān)節(jié)感染的病例,其中髖關(guān)節(jié)置換術(shù)后感染6例(失訪1例,實際隨訪5例),膝關(guān)節(jié)術(shù)后感染8例。保留假體的關(guān)節(jié)清創(chuàng)術(shù)前常規(guī)檢查C反應蛋白,降鈣素原(PCT),所有病例術(shù)前均行關(guān)節(jié)穿刺細菌培養(yǎng),術(shù)中常規(guī)行關(guān)節(jié)液常規(guī)與細菌培養(yǎng)。髖關(guān)節(jié)清理時應脫出股骨頭后徹底清理關(guān)節(jié)內(nèi)炎性病灶。膝關(guān)節(jié)清理時應取出聚乙烯襯墊,徹底清除關(guān)節(jié)囊內(nèi)可疑感染病灶,更換新的聚乙烯襯墊。常規(guī)留置引流管,并關(guān)節(jié)腔內(nèi)局部抗生素治療。所有保留假體清創(chuàng)病例術(shù)后均采用相對應的敏感抗生素治療3個月,并定期隨訪CRP指標、血沉(ESR)及關(guān)節(jié)功能情況。結(jié)果?本組13例采取保留假體的急性人工關(guān)節(jié)感染中,平均隨訪:20.69月(9.15-35.45月),其中9例成功保留假體,平均隨訪時間17.33月(7.50-36.35月),感染無復發(fā),4例保留假體失敗(膝關(guān)節(jié)3例,1例髖關(guān)節(jié));平均隨訪時間28.25月(5.33-50.00月);保留假體成功率為69.2%。?9例治療成功的患者從出現(xiàn)癥狀到清創(chuàng)平均時間間隔14.44d(9.00-20.67d);4例治療失敗的患者從出現(xiàn)癥狀到清創(chuàng)平均時間間隔7.5d(4-10d),兩組清創(chuàng)時間間隔經(jīng)t檢驗分析,無統(tǒng)計學意義,及兩組清創(chuàng)間隔時間無差異(t=1.449,P0.005)?13例急性人工關(guān)節(jié)感染術(shù)前或術(shù)中細菌培養(yǎng)結(jié)果顯示:9例為葡萄球菌屬感染,占69.2%,其中金黃色葡萄球菌感染2例,耐甲氧西林金黃色葡萄球菌1例,表皮葡萄球菌4例(包括耐甲氧西林表皮葡萄球菌3例),頭狀葡萄球菌1例,溶血葡萄球菌1例;其余病原體中大腸埃希菌3例,占27.3%;最后1例為糞腸球菌。結(jié)論保留假體清創(chuàng)對于急性人工關(guān)節(jié)感染中有一定價值,成功率為69.2%,應充分把握時機和適應證。
[Abstract]:Objective acute prosthetic joint infection (APJI) after artificial joint replacement is one of the main complications, often occurs in the early postoperative period or hematogenous spread. For acute prosthetic joint infection, perioperative comprehensive preserving prosthesis debridement combined with antibiotic therapy is the treatment of one of the means, and the success rate of the early measures about 60-80%., this study aimed to investigate the therapeutic effect of APJI by debridement and component retention combined with antibiotic use. Methods a retrospective analysis from 2011~2014 in our hospital 14 cases of acute infection of artificial joints adopt artificial joint replacement prosthesis retention combined with antibiotics in the treatment of the cases, the hip arthroplasty infection in 6 cases (lost in 1 cases, 5 cases were followed up), 8 cases of knee joint prosthesis retention. Postoperative infection after joint debridement routine examination before C reactive protein, procalcitonin (PCT), all patients underwent preoperative joint puncture Bacterial culture, routine operation in joint fluid routine and bacterial culture. We should thoroughly clean after removing femoral head intra-articular inflammatory lesion of hip cleaning. Knee joint cleaning should remove the polyethylene liner, completely remove the intraarticular suspected infection lesions, polyethylene liner exchange new. The conventional indwelling drainage tube, and joint cavity the local antibiotic therapy. All cases of postoperative debridement and component retention using sensitive antibiotic corresponding treatment for 3 months, and regular follow-up CRP index, erythrocyte sedimentation rate (ESR) and joint function. Results? 13 cases of this group take prosthesis retention acute artificial joint infection, mean follow-up of 20.69 months (9.15-35.45 months:), including 9 cases of successful retention of the prosthesis, the average follow-up time of 17.33 months (7.50-36.35 months), no recurrence of infection, 4 cases of retained prosthesis failure (3 cases, 1 cases of knee joint and hip joint); the average follow-up time of 28.25 months (5.33-50.00 months); retention of the prosthesis into The power is 69.2%.? 9 cases of successful treatment of patients suffering from symptoms to debridement and average time interval 14.44d (9.00-20.67d); 4 cases of treatment failure patients from onset of symptoms to debridement and average time interval 7.5d (4-10d), two groups of debridement time interval by t test analysis, no statistical significance, and two groups of Qing Dynasty a time interval difference (t=1.449, P0.005)? Preoperative bacterial culture results showed that 13 cases of acute prosthetic joint infection: 9 cases of Staphylococcus infection, accounted for 69.2%, of which 2 cases of infection of Staphylococcus aureus, methicillin resistant Staphylococcus aureus in 1 cases, 4 cases of Staphylococcus epidermidis (including methicillin-resistant Staphylococcus epidermidis in 3 cases), 1 cases of Staphylococcus capitis, 1 cases of hemolytic Staphylococcus; Escherichia coli and other pathogens in 3 cases, accounting for 27.3%; the last 1 were Enterococcus faecalis. Conclusion debridement and component retention for a certain value of acute prosthetic joint infection, success The rate is 69.2%, and the timing and indications should be fully grasped.

【學位授予單位】：福建醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2015
【分類號】：R687.4

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本文編號：1741458