摘要目的 探讨采用可活动关节间隔垫技术的二期再置换术治疗人工全膝关节表面置换术后深部感染的疗效.方法 2007年4月至2011年8月共收治人工全膝关节表面置换术后深部假体感染患者11例,男2例,女9例；年龄56～ 68岁,平均61岁.4例合并糖尿病.患者均采用二期再置换手术治疗:第一期手术取出假体,彻底清创,植入含抗生素的可活动间隔垫,术后抗感染治疗8 ～ 10周.感染控制后二期取出可活动间隔垫,植入新的关节假体.采用美国特种外科医院(HSS)评分评价治疗效果.结果 所有患者均获随访,随访时间13 ～ 40个月,平均22个月.随访期内无一例发生感染复发或其他并发症.术前患膝HSS评分34 ～ 62分,平均48分；二期手术前HSS评分61 ～90分,平均76分；最后随访时HSS评分76～94分,平均88分.一期术前、二期术前及二期术后最后随访时患膝关节功能的优良率分别为0、73％和100％.结论 采用可活动关节间隔垫片的二期翻修术是治疗人工膝关节感染的一种安全有效的方法,可有效地控制感染并可较好地保留关节功能.

abstractsObjective To investigate the effects of second-stage revision surgery with mobile cement spacer in the treatment of deep infection following primary knee arthroplasty.Methods From April 2007 to August 2011,eleven patients who suffered from infected total knee arthroplasty were treated with second-stage revision arthroplasty using mobile cement spacer.There were two males and nine females with an average age of 61 years(range,56-68 years).The first stage operation included prosthesis removal,radical debridement,insertion of antibiotic-impregnated mobile cement spacer.Then the patients received antibiotic treatment for a period of 8-10 weeks.When the infection was controlled,the second operation was done with removal of the spacer and reimplantation of new rotatory hinged knee prothesis.HSS rating scale was used for assessment of outcomes.Results All the patients were followed for a mean period of 22 months(range,13-40 months).No recurrence of infections or other complications were noted.Preoperative HSS scores averaged 48 points(range,34-62 points).Prior to the second operation,HSS scores increased to an average of 76 points(range,61-90 points).At final follow-up,the average HSS score was 88 points(range,76-94 points).The satisfactory rate of the knee function for pre-first operation,pre-second operation,and final follow-up was 0,seventy-three percent,and one hundred percent respectively.Conclusions Second-stage revision surgery with mobile cement spacer is effective and safe for the treatment of infected knee arthroplasty with well preserved knee function.