人工關節周邊關節感染兩階段人工關節再置換術之再植入時間點治療經驗及文獻回顧

Timing of Re-implantation for Periprosthetic Infection --- KTGH Experience and Literature Review

許芳偉(Fang-Wei Hsu) ； 吳承哲(Chen-Che Wu) ； 李芳材(Fang-Tsai Lee) ； 王迺輝(Nai-Hwei Wang) ； 王乃弘(Nai-Phon Wang)

《中華職業醫學雜誌》 23卷4期 (2016/10) Pp. 245-251

摘要

簡介：人工關節周邊關節感染(Periprosthetic joint Infection)是人工髖關節(THR)及人工膝關節(TKA)術後最具災難性且處理困難的併發症之一。兩階段的人工關節再置換術(revision arthroplasty)是針對人工關節周邊關節感染最常見的手術治療方式。多數早期的研究顯示兩階段人工關節再置換術成功率約70%至90%。然而，有部分研究顯示感染再復發率仍然很高，並且沒有標準的治療方針告訴我們第二階段人工關節的再植入時機點。分析過去15年來針對人工關節周邊關節感染的治療經驗並且與過去的研究比較我們的手術結果。此研究同時試著建立針對第二階段人工關節再植入時機點的標準治療方針。研究方法：回朔過去15年(2001-2015)共分析37個因人工關節周邊關節感染接受兩階段人工關節再置換術的個案。其平均年齡約56.89歲。其中有15人是接受全人工膝關節再置換術(39.5%)，22人是接受全人工髖關節再置換術(60.5%)。其中有2人因嚴重內科疾病死亡。術前術後的實驗室血清學檢查包含CRP、ESR及臨床表徵皆收入分析。結論：我們分析了第一階段人工關節移除前以及第二階段人工關節再植入後的血清學數據及臨床表徵。失敗率約28.9%(11/37個案)。治療方針及其餘相關因子也納入分析。先前的文獻及適當的再植入時機點將被研究及建議。

關鍵字

人工關節周邊關節感染 ； 兩階段人工關節再置換術

並列摘要

Introduction: Periprosthetic joint infection (PJI) is one of the most catastrophic and difficult complications to deal with following total hip and total knee arthroplasty. Two-stage revision arthroplasty is the most common surgical approach for periprosthetic joint infection. Several previous studies reported that the success rate of two-stage revision arthroplasty was around 70% to 90%. However, some studies revealed that the infection recurrence rate was still high, and there is no guideline of timing for second-stage reimplantation. We analyzed our experiences from the past 15 years and compared our results to the previous reports and aim to establish the guideline of timing for second-stage reimplantation. Materials and Methods: We retrospectively reviewed total 38 cases from the past 15 years (2001-2015). All patients received two-stage revision arthroplasty for periprosthetic infection. The mean age was 56.89 years old. Total 15 patients received TKR revision (39.5%) and 23 received THR revision (60.5%). Two patients died of worse general condition. One received the knee arthrodesis. We followed up CRP, ESR, and clinical signs of infection for evaluation of the postoperative joint. Results: We collected the data of the recurrently infected postoperative joints. The recurrent rate was high around 28.9% (11 of 38). Total 11 patients received the further debridement or arthrotomy for recurrent infection. Other 27 cases showed normal CRPs and no clinical signs of infection during our follow-up. Discussion: Compared to previous studies, our experience showed higher recurrent infection rate. The comorbidities of these patients was one of the reasons for the flare-up of infection. The principle of timing for second-stage reimplantation needs being modified rigorously.

並列關鍵字

Periprosthetic joint Infection ； Two stage revision arthroplasty