本文選題：關(guān)節(jié)成形術(shù) + 感染��； 參考：《新疆醫(yī)科大學》2015年碩士論文

【摘要】：目的：報告人工髖、膝關(guān)節(jié)置換術(shù)后假體周圍慢性感染病原菌培養(yǎng)方法,分析培養(yǎng)結(jié)果。方法：回顧性分析自2010年9月至2014年3月收治的全膝關(guān)節(jié)置換術(shù)(total knee arthroplasty TKA)及全髖關(guān)節(jié)置換術(shù)(total hip arthroplasty THA)術(shù)后被明確診斷為假體周圍慢性感染的患者23例。其中TKA 15例,THA8例；男12例,女11例；年齡32-79歲,平均62歲；伴有竇道患者9例。患者均在關(guān)節(jié)腔穿刺前至少2周停用抗生素治療,翻修術(shù)前及術(shù)中分別取關(guān)節(jié)液予以病原菌培養(yǎng)及藥敏試驗。術(shù)中組織行一般病原菌培養(yǎng)及病理活檢,培養(yǎng)結(jié)果為陰性的樣本延長至2周。結(jié)果：本組患者共23例,術(shù)前培養(yǎng)1周陽性率30.4%(7/23),陰性樣本延長至兩周陽性率39.1%(9/23)。分析原因可能與所取關(guān)節(jié)液量不足,穿刺中抑菌成分帶入,培養(yǎng)時間不足等因素有關(guān)。術(shù)中培養(yǎng)1周陽性率60.9%(14/23),陰性樣本延長至兩周陽性率82.6%(19/23),7例(30.4%)術(shù)前及術(shù)中培養(yǎng)結(jié)果相符。結(jié)論：對人工髖、膝關(guān)節(jié)置換術(shù)后假體周圍慢性感染行病原菌培養(yǎng),在明確診斷前停用抗生素至少2周,嚴格無菌的標本處理,合理延長培養(yǎng)時間,與微生物室緊密協(xié)作,能明顯提高病原菌培養(yǎng)的陽性率,合理指導(dǎo)臨床針對性使用抗生素,提高翻修術(shù)后感染控制率。
[Abstract]:Objective: to report the culture method of pathogenic bacteria of chronic infection around prosthesis after hip and knee arthroplasty, and to analyze the results of culture. Methods: from September 2010 to March 2014, 23 patients with chronic periprosthetic infection were analyzed retrospectively after total knee arthroplasty (total knee arthroplasty tha) and total hip arthroplasty (total hip arthroplasty tha). There were 15 cases of TKA with THA, including 12 males and 11 females, aged 32-79 years (mean 62 years), and 9 patients with sinus tract. All the patients stopped antibiotic therapy at least 2 weeks before articular cavity puncture. The synovial fluid was collected before revision and intraoperative respectively for pathogen culture and drug sensitivity test. Tissue culture and pathological biopsy were performed during the operation, and the negative samples were prolonged to 2 weeks. Results: the positive rate was 30.4% (7 / 23) in 1 week before operation, and 39.1% (9 / 23) in negative samples. The analysis may be related to the insufficient amount of joint fluid taken, the introduction of bacteriostasis in puncture, and the shortage of culture time. The positive rate of 1 week culture was 60.9% (14 / 23), and the positive rate of negative samples was 82.6% (19 / 23). Conclusion: the pathogens of chronic infection around prosthesis after hip and knee arthroplasty were cultured, antibiotics were stopped for at least 2 weeks before diagnosis, strict sterile specimen treatment, reasonable extension of culture time, and close cooperation with microorganism room. It can obviously improve the positive rate of pathogen culture, reasonably guide the clinical use of antibiotics, and improve the infection control rate after revision operation.
【學位授予單位】：新疆醫(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：2068033