THE INFECTED KNEE ARTHROPLASTY - A 6-YEAR FOLLOW-UP OF 357 CASES
THE INFECTED KNEE ARTHROPLASTY - A 6-YEAR FOLLOW-UP OF 357 CASES
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DOI：
10.3109/17453679108994458
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发表时间：
1991-08-01
期刊：
影响因子：
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通讯作者：
KNUTSON, K
中科院分区：
文献类型：
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作者：
BENGTSON, S;KNUTSON, K
1975年10月1日至1985年，瑞典进行了12，118例初次膝关节置换术，平均随访6年，关节病和类风湿性关节炎的深部感染发生率分别为1.7%和4.4%。感染的危险因素是大型假体、术后伤口愈合并发症、类风湿性关节炎、既往深部感染和皮肤感染。我们分析了357例膝关节置换术后深部感染的治疗。225例膝关节主要使用全身抗生素，44例膝关节感染愈合，其中20例在最终随访时假体功能正常;治疗未影响后期翻修手术。154个膝关节接受了软组织手术，其中37个愈合，15个有功能性假体。切除关节成形术导致22个膝关节中11个感染愈合。在107个膝关节中进行了翻修关节成形术，81个膝关节的感染最终愈合，其中36个膝关节具有功能性假体;一期和二期手术的结局没有差异。在135个膝关节中尝试了关节固定术，120个膝关节感染最终愈合，105个膝关节融合。22名患者被截肢。因此，315个膝关节（88%）的感染愈合，但只有71个（20%）恢复了功能性假体，8名患者死于感染。因此，注意力应集中在针对软组织问题的预防措施上-避免冲突的皮肤切口，温和地处理关节周围软组织，避免使用限制性假体和过大的间室假体，让伤口愈合优先于软组织受损的膝关节的运动，并对皮肤溃疡进行预防性抗生素治疗，直到这些溃疡愈合。
The incidence of deep infection after 12,118 primary knee arthroplasties performed in Sweden from October 1, 1975 through 1985 with a median follow-up of 6 years was 1.7 percent for arthrosis and 4.4 percent for rheumatoid arthritis. Risk factors for infection were large prostheses, postoperative wound-healing complications, rheumatoid arthritis, a prior deep infection, and skin infections. We have analyzed the treatment of 357 knee arthroplasties with a deep infection. Systemic antibiotics alone were primarily used in 225 knees, with healing of the infection in 44 knees, 20 of which had a functioning prosthesis at the final follow-up; the treatment did not compromise later revision surgery. Soft-tissue surgery was used in 154 knees-37 healed, 15 of which had a functioning prosthesis. Resection arthroplasty resulted in healing of the infection in 11 of 22 knees. Revision arthroplasty was performed in 107 knees, with eventual healing of the infection in 81 knees, 36 of which had a functioning prosthesis; there were no differences in the outcome of one-stage and two-stage procedures. Arthrodesis was attempted in 135 knees, with eventual healing of the infection in 120 knees and fusion in 105. Twenty-two patients were amputated. Thus, the infection healed in 315 knees (88 percent), but only 71 (20 percent) recovered with a functioning prosthesis, and 8 patients died of the infection. Attention should therefore focus on prophylactic measures directed towards the soft-tissue problems-by avoiding conflicting skin incisions, by gentle handling of the periarticular soft tissues, by avoiding the use of constrained prostheses and oversized compartmental prostheses, by letting wound healing take priority over motion in knees with compromised soft tissues, and by using prophylactic antibiotic treatment for skin ulcers until these have healed.