Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre
Outcome of prosthetic knee-associated infection: evaluation of 40 consecutive episodes at a single centre
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DOI：
10.1111/j.1469-0691.2006.01378.x
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发表时间：
2006-05-01
影响因子：
14.2
通讯作者：
Zimmerli, W
中科院分区：
文献类型：
--
作者：
Laffer, RR;Graber, P;Zimmerli, W
很少有研究比较不同手术策略在人工膝相关感染中的长期成功。因此，对1988年至2003年期间在一个中心接受人工膝关节相关感染翻修手术的35名连续患者的40次发作进行了回顾性队列研究。中位患者年龄为70（44-90）岁;中位随访期为28（2-193）个月; 45%的感染为早期，23%为延迟，32%为晚期; 55%的感染由葡萄球菌引起。1年后无假体失效的生存概率为92.4%（95%CI，84.1-100），2年后为88.7%（95%CI，78-99.4）。21例接受清创和保留治疗的患者中有20例（95%）观察到无复发生存，两例患者均接受一期交换，13例患者中有11例（85%）接受二期交换。迟发性感染患者的预后比早期或晚期感染患者差（67% vs. 97%; p < 0.03）。至少部分充分抗菌治疗的患者的成功率高于治疗不充分的患者（94% vs. 60%; p 0.069）。治疗持续时间为3至< 6个月的患者和治疗持续时间>= 6个月的患者的结局相似（91% vs. 87%成功）。不同的外科手术有相似的成功率，只要考虑到感染的类型、病原体、植入物的稳定性以及局部皮肤和软组织状况。坚持一个算法定义一个合理的手术和抗生素治疗策略有助于一个有利的结果。
Few studies have compared the long-term success of different surgical strategies in prosthetic knee-associated infection. Accordingly, a retrospective cohort study was performed of 40 episodes in 35 consecutive patients undergoing revision surgery for prosthetic knee-associated infection at a single centre between 1988 and 2003. The median patient age was 70 (44-90) years; the median follow-up period was 28 (2-193) months; 45% of infections were early, 23% were delayed, and 32% were late; and 55% of infections were caused by staphylococci. The probability of survival without prosthesis failure was 92.4% (95% CI, 84.1-100) after 1 year, and 88.7% (95% CI, 78-99.4) after 2 years. Recurrence-free survival was observed in 20 (95%) of 21 patients treated with debridement and retention, in both patients with one-stage exchange, and in 11 (85%) of 13 patients with two-stage exchange. Patients with delayed infection had a worse outcome than those with early or late infection (67% vs. 97%; p < 0.03). Patients with at least partially adequate antimicrobial therapy had a higher success rate than those with inadequate treatment (94% vs. 60%; p 0.069). The outcome was similar for patients with a duration of therapy of 3 to < 6 months, and those with a duration of therapy of >= 6 months (91% vs. 87% success). Different surgical procedures had similar success rates, provided that the type of infection, the pathogen, the stability of the implant and the local skin and soft-tissue condition were considered. Adherence to an algorithm defining a rational surgical and antibiotic treatment strategy contributed to a favourable outcome.