Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty
Systemic safety of high-dose antibiotic-loaded cement spacers after resection of an infected total knee arthroplasty
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DOI：
10.1097/01.blo.0000144476.43661.10
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发表时间：
2004-10-01
影响因子：
4.2
通讯作者：
Jacofsky, DJ
中科院分区：
文献类型：
--
作者：
Springer, BD;Lee, GC;Jacofsky, DJ
这项研究的目的是评估感染的全膝关节置换术后使用大剂量抗生素浸渍的骨水泥垫片的全身安全性和潜在的不良反应。2000年10月至2002年12月，36个膝关节(34名患者)接受了全膝关节假体切除置换术，置入大剂量抗生素浸渍的骨水泥垫片。男24例，女10例，年龄48~84岁，平均66.5岁。所有放置的间隔物平均含有3.4批水泥，平均总剂量为10.5g万古霉素(范围为3-16g)和12.5g庆大霉素(范围为3.6-19.2g)。对所有患者进行术后随访，直至再次植入，以确定是否有肾功能衰竭的证据。术前肌酐0.7~1.8 mg/dL。所有患者同时接受6周的静脉注射机体特异性抗生素治疗。1例术前肾功能正常(Cr0.7 mg/dL)的患者围手术期有一过性血肌酐升高(1.7 mg/dL)，随后恢复正常。没有患者表现出任何急性肾功能不全、衰竭或抗生素的其他全身副作用的临床证据。使用大剂量万古霉素和庆大霉素抗生素间隔物治疗感染的全膝关节置换术患者似乎是临床安全的。
The purpose of this study was to assess the systemic safety and potential adverse effects of using a high-dose antibiotic-impregnated cement spacer after resection arthroplasty of an infected total knee replacement. Between October 2000 and December 2002, 36 knees (34 patients) had a resection arthroplasty of an infected total knee prosthesis with placement of a high-dose antibiotic impregnated cement spacer. There were 24 men and 10 women with a mean age of 66.5 years (range, 48-84 years). All spacers placed contained an average of 3.4 batches of cement with an average total dose of 10.5 g of vancomycin (range, 3-16 g) and 12.5 g of gentamicin (range, 3.6-19.2 g). All patients were followed up postoperatively until reimplantation for evidence of renal failure. The preoperative creatinine ranged from 0.7 to 1.8 mg/dL. All patients were concomitantly treated with 6 weeks of intravenous organism-specific antibiotics. One patient with normal preoperative renal function (Cr 0.7 mg/dL) had a perioperative 1-day transient rise in serum creatinine (1.7 mg/dL) postoperatively that subsequently normalized. No patients showed any clinical evidence of acute renal insufficiency, failure, or other systemic side effects of the antibiotics. Treatment of patients with an infected total knee arthroplasty with high-dose vancomycin and gentamicin antibiotic spacers seems to be clinically safe.