Deep sepsis following total knee arthroplasty. Ten-year experience at the University of California at Los Angeles Medical Center.
Deep sepsis following total knee arthroplasty. Ten-year experience at the University of California at Los Angeles Medical Center.
复制标题
全膝关节置换术后深度脓毒症。
DOI：
--
复制
发表时间：
1986
期刊：
影响因子：
--
通讯作者：
H. Amstutz*
中科院分区：
文献类型：
--
作者：
T. Grogan;F. Dorey;J. Rollins;H. Amstutz*
1971年9月至1982年5月，在加州大学洛杉矶医学中心，604名患者接受了821例全膝关节置换术，所有患者均接受了围手术期抗生素治疗。深度脓毒症，经术后关节穿刺标本阳性培养证实，在12例患者的13个膝关节中发生了14次，发病率为1.71%。其中一例患有系统性红斑狼疮和双侧膝关节置换术的患者，右膝关节在两个不同的情况下感染了两种不同的微生物（间隔10个月）。第一种感染可能是血源性的，而第二种感染是在牙科手术后发生的，肯定是血源性的。总体而言，5例感染为血源性感染，来源已确定，另1例疑似血源性感染。从手术到诊断败血症的平均时间为8.3个月，但14例感染中有5例在关节置换术后不到两个月就被发现。对于假定为血源性感染的6例患者，从手术到诊断为败血症的平均时间为16.4个月。14例感染中有13例主要表现为疼痛。14例感染的初始治疗包括所有患者静脉注射抗生素，1例患者在5天后首次取出假体并进行所谓的置换关节成形术，1例患者取出假体并进行融合，6例患者进行关节切开术并进行关节切除术，3例患者进行关节镜冲洗，3例患者单独使用抗生素（其中1例患者在3周后进行了置换关节成形术）。在最后的随访中，13个假体中只有4个被打捞出来。（摘要删节250字）
Between September 1971 and May 1982, at the University of California at Los Angeles Medical Center, 821 total knee arthroplasties were performed in 604 patients, all of whom received perioperative antibiotics. Deep sepsis, proved by a positive culture of a specimen obtained by postoperative arthrocentesis, developed fourteen times in thirteen knees of twelve patients, an incidence of 1.71 per cent. In one of these patients, who had systemic lupus erythematosus and bilateral knee replacement, the right knee became infected with two distinct organisms on two different occasions (separated by ten months). The first infection was probably hematogenous while the second, developing after a dental procedure, definitely was. Over-all, five infections were hematogenous with an identified source and one other was suspected of having a hematogenous origin. The time from operation to the diagnosis of sepsis averaged 8.3 months over-all, but five of the fourteen infections were recognized less than two months after arthroplasty. For the six infections that were assumed to be hematogenous, the time from operation to the diagnosis of sepsis averaged 16.4 months. The major presenting symptom was pain in thirteen of the fourteen infections. The initial treatments of the fourteen infections consisted of intravenous antibiotics in all of them, primary removal of the prosthesis and so-called exchange arthroplasty after five days in one, removal of the prosthesis and fusion in one, arthrotomy and débridement in six, arthroscopic irrigation in three, and antibiotics alone in three (of which one was treated with an exchange arthroplasty after three weeks). At last follow-up, only four of the thirteen prostheses had been salvaged.(ABSTRACT TRUNCATED AT 250 WORDS)