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一期翻修联合关节腔内注射抗真菌药物治疗慢性假体周围真菌感染的效果评价

Efficacy evaluation of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection

摘要:

目的 探讨一期翻修联合关节腔内注射抗真菌药物治疗慢性假体周围真菌感染的临床效果.方法 回顾性分析2004年1月至2016年8月因假体周围真菌感染于新疆医科大学第一附属医院关节外科接受人工关节一期翻修联合关节腔内注射抗真菌药物的11例(4髋,7膝)患者的临床资料.男性4例,女性7例,年龄67岁(范围:47~ 77岁).所有患者在术中先行彻底清创,取3~5处明显感染性病变的组织样本及液体样本立即送往微生物实验室进行微生物培养及药物敏感性实验.随后取出人工关节假体,彻底清除骨水泥碎片,使用大量生理盐水及必妥碘反复清洗、浸泡术区.重新铺单,更换手术器械,将0.5 g万古霉素撒入髓腔,此后,人工髋关节置换术后假体周围感染患者置入新的非骨水泥假体,人工膝关节置换术后假体周围感染患者在骨水泥中加入0.5 g庆大霉素.术后给予静脉及局部长期抗菌药物及抗真菌药物的联合治疗.术前、术后采用Harris髋关节评分(HHS)或美国特种外科医院膝关节评分(HSS)评价患肢功能.数据分析采用配对样本t检验.结果 所有患者均得到随访,随访时间5年(范围:2~ 12年).3例患者感染复发,8例患者疗效满意,至末次随访均未出现复发感染.8例患者中,4例髋关节翻修患者HHS由术前的(39.25±5.12)分提高至末次随访时的(79.50±4.79)分,差异有统计学意义(t=-11.356,P=0.001);4例膝关节翻修患者HSS由术前的(46.25±5.61)分提高至末次随访时的(80.50±5.06)分,差异有统计学意义(t=-9.930,P=0.002).结论 人工关节一期翻修联合关节腔内注射抗真菌药物治疗假体周围真菌感染可获得较理想的临床效果.

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abstracts:

Objective To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection.Methods A retrospective analysis of 11 patients(4 hips,7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years(range:47-77 years).Each patient underwent single-stage revision including aggressive soft-tissue debridement.Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis.Removed the infected components and cement thoroughly,pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics.The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that,a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation.Recurrence of infection and clinical outcomes were evaluated.The follow-up period was 5 years (range:2-12 years).Results One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection.The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79,the difference was statistically significant (t=-11.356,P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25± 5.61 to final follow-up 80.50±5.06,and the difference was statistically significant (t=-9.930,P=0.002).Conclusion Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.

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