负压封闭式引流联合碘伏灌洗治疗人工关节置换后假体感染

摘要

背景：假体感染是人工关节置换后的灾难性并发症，目前多数认为二期翻修是主要的治疗方法，但手术创伤大，住院期长，花费巨大，且疗效不是十分确切，有的需多次手术，个别病例甚至需要截肢。目的：探讨负压式封闭引流联合碘伏灌洗对人工关节置换后假体感染的治疗效果。方法：纳入9例人工关节置换后假体感染患者，6膝，3髋，平均年龄63.4岁；置换后7 d-14个月发生感染，中位时间1个月；均见脓性或脓血性分泌物，2例形成窦道，1例切口、引流口未愈合，结合细菌培养结果符合临床假体感染诊断。均保留假体进行清创，清创后负压式封闭引流，每天行碘伏灌洗，30-50 mL不等，夹闭近端引流管30 min后重新开始持续负压式引流治疗。治疗后定期随访，评估负压式封闭引流联合碘伏灌洗对人工关节置换后假体感染的治疗效果。结果与结论：①除1例未愈，1例死亡，1例肿瘤型假体失败最后截肢外，其余6例均治愈；②6例患者负压式封闭引流联合碘伏灌洗时间为10-84 d，中位时间57 d，治疗过程中无并发症及不良反应发生。治愈患者均获随访，随访时间12-60个月，无复发病例；③结果说明，负压式封闭引流术联合碘伏灌洗最大程度的保留了假体，简单、安全、费用低，治疗假体感染效果显著，是人工关节置换后假体感染可选择的一种疗法。%BACKGROUND:Periprosthetic infection after artificial joint replacement is a disastrous complication for a patient. Currently, during treating for the periprosthetic infection, most of patients need two-stage revision, which bring about enormous physical and psychological pain for patients, and a heavy burden for the families and society. To make matters worse, the effect is not very perfect, and some of these cases require multi-stage revision, even amputation. OBJECTIVE:To investigate the therapeutic effect of vacuum sealing drainage combined with iodophor douche for the infection after artificial joint replacement. METHODS:Nine cases (six knees and three hips) of infection after artificial joint replacement were col ected, with an average age of 63.4 years. Infection occurred at 7 days-14 months, and a median time of 1 month after replacement. Al patients suffered from purulent or purulent blood secretion. Fistula formed in two cases and incision and drainage sites were not healed in one case. According to the bacterial culture results, above symptoms were accorded with clinical diagnosis of prosthesis infection. The prosthesis was remained for debridement. Vacuum sealing drainage was performed. Iodophor douche (30-50 mL) was conducted every day. The drainage tube at proximal end was occluded for 30 minutes, and then vacuum sealing drainage was performed. Al patients were regularly fol owed up to assess the therapeutic effects of vacuum sealing drainage combined with prosthesis infection after replacement. RESULTS AND CONCLUSION:(1) Except that one case was stil in treatment, one case was dead, and one case of tumor prosthesis was failure and final y amputated, the remaining six patients were healed. (2) The time of vacuum sealing drainage and iodophor douche was 10 to 84 days, with the median time of 57 days. No adverse reactions or complications occurred. Al healed patients were fol owed up for 12-60 months, without recurrence. (3) These results indicated that vacuum sealing drainage combined with iodophor douche retained the prosthesis to the greatest degree, is simple, safe, and effective for the infection after artificial joint replacement, needs a low cost, and is a kind of therapy for prosthesis infection after artificial joint replacement.