本文選題：spacer + 假體周圍感染��； 參考：《山東大學(xué)》2016年碩士論文

【摘要】：目的探討兩種spacer在二期翻修治療TKA術(shù)后假體周圍感染患者的臨床效果,并比較二者療效。方法回顧我院自2011年1月至2015年9月因TKA術(shù)后假體周圍感染接受二期翻修手術(shù)治療的患者20例,其中男13例,女7例；年齡56-77歲,平均64.6歲。TKA術(shù)后感染患者在二期翻修手術(shù)治療Ⅰ期手術(shù)徹底清創(chuàng)后,其中8例TKA術(shù)后患者,選擇應(yīng)用再次消毒后的原股骨假體、對(duì)應(yīng)型號(hào)的新聚乙烯墊片和加載敏感抗生素的骨水泥作為spacer;12例TKA術(shù)后患者,選擇應(yīng)用經(jīng)典的骨水泥spacer,并且所有患者膝關(guān)節(jié)內(nèi)均加入萬古霉素自固化磷酸鈣顆�？垢腥局委�,確認(rèn)感染控制后行Ⅱ期膝關(guān)節(jié)翻修手術(shù)。術(shù)后觀察感染控制情況和關(guān)節(jié)功能恢復(fù)情況。結(jié)果使用再次消毒的原股骨假體為spacer(關(guān)節(jié)型)的患者(Ⅰ組,n=8)與使用經(jīng)典骨水泥spacer的患者(Ⅱ組,n=12)進(jìn)行比較,隨訪時(shí)間6-48個(gè)月,平均27個(gè)月,結(jié)果顯示二期翻修Ⅰ期手術(shù)spacer放置后Ⅰ組有更好的關(guān)節(jié)活動(dòng)度(85±12)°vs(35±20)。,P0.001,KSS評(píng)分[65(0～79)vs22(1～57),P=0.026]也更高；同樣二期翻修Ⅱ期手術(shù)后Ⅰ組也有更好的關(guān)節(jié)活動(dòng)度(106±16)°vs(89±18)。,P0.001),KSS評(píng)分[90(20～95)vs83(15～89),P=0.015]也更高。兩組20例患者復(fù)發(fā)感染僅有1例(感染控制率為95%),而兩組間的感染復(fù)發(fā)率無統(tǒng)計(jì)學(xué)差異。結(jié)論再次消毒后的原股骨假體、對(duì)應(yīng)型號(hào)的新聚乙烯墊片和抗生素骨水泥組成的spacer在治療TKA術(shù)后假體周圍感染患者上可以帶來更好的運(yùn)動(dòng)范圍和功能,有更好的臨床前景。
[Abstract]:Objective to investigate the clinical effect of two kinds of spacer in the treatment of periprosthetic infection after TKA, and to compare their efficacy. Methods from January 2011 to September 2015, 20 patients (13 males and 7 females) who underwent secondary revision surgery due to periprosthetic infection after TKA were reviewed. An average of 64.6 years old patients with infection after operation of TKA were treated with primary stage I operation complete debridement after second-stage revision surgery. Among them, 8 cases of TKA patients were selected to use proto-femur prosthesis after re-disinfection. The corresponding new polyethylene gasket and bone cement loaded with sensitive antibiotics were used as spacer in 12 patients after TKA operation. The classic bone cement spacer was used in all patients, and vancomycin self-solidified calcium phosphate granules were added to the knee joint for anti-infection therapy. Stage 鈪，

本文編號(hào)：2095260