膝关节假体周围感染翻修术后假体生存状况的研究

Survival status of prosthesis of patients with peripheral infections ofknee joint prosthesis after revision surgery

  • 摘要: 目的 探索膝关节假体周围感染进行再翻修手术后假体的生存状况、治疗效果以及相关的影响因素,为临床治疗提供参考。方法 选取2006年1月-2016年1月于医院接受治疗的82例膝关节假体周围感染患者为研究对象,按照一年后患者假体感染状况分为生存组58例和再感染组24例,对患者的一般资料进行回顾性分析,采集感染患者假体周围临床样本进行细菌培养及鉴定,比较两组患者降钙素原(PCT)、C-反应蛋白(CRP)、红细胞沉降率(ESR)等常规指标,采用国际视觉痛觉评价量表(VAS)、运动功能评价量表(包括运动能力以及关节活动能力等)对患者的痛觉、运动功能等进行评价分析。结果 生存组以及再感染组患者年龄、病程之间差异无统计学意义。基础性疾病比较差异有统计学意义(P<0.05); 再感染组患者PCT、CRP、ESR等指标水平均高于生存组患者(P<0.05); 生存组患者运动能力和关节活动能力评分高于再感染组(P<0.05),再感染组患者疼痛感程度较生存组强烈,VAS评分高于生存组(P<0.05); 感染患者假体周围关节分泌液共检出病原菌43株,其中以金黄色葡萄球菌以及表皮葡萄球菌为主。结论 膝关节假体周围感染再翻修手术生存状况与患者基础疾病、运动能力和关节活动能力有关,检测PCT、CRP、ESR等常规指标能够有效预测膝关节假体周围感染再翻修术后假体的生存状况。

     

    Abstract: OBJECTIVE To explore the survival status of prosthesis of patients with peripheral infections of knee joint prosthesis after revision surgery, observe the therapeutic effect and analyze the related influencing factors so as to provide guidance for clinical treatment. METHODS A total of 82 patients with peripheral infections of knee joint prosthesis who were treated in the hospital from Jan 2006 to Jan 2016 were recruited as the study objects and divided into the survival group with 58 cases and the reinfection group with 24 cases according to the status of prosthesis infections, the baseline data of the patients were retrospectively analyzed, the peripheral specimens of prosthesis of the patients with infections were collected for bacterial culture and identification, the routine indexes such as procalcitonin (PCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were compared between the two groups of patients, and the sense of pain and motor function were evaluated and analyzed by using visual-analogue scale (VAS) and motor function evaluation scale (including exercise capacity and joint motion capabilities). RESULTS There was no significant difference in the age or disease course between the survival group and the re-infection group; there were significant differences in underlying diseases between the two groups (P<0.05).The levels of PCT, CRP and ESR of the reinfection group were significantly higher than those of the survival group(P<0.05).The scores of exercise capacity and joint motion capabilities of the survival group were significantly higher than those of the reinfection group, the degree of pain feeling of the reinfection group was significantly higher than that of the survival group, the VAS score of the reinfection group was significantly higher than that of the survival group(P<0.05).Totally 43 strains of pathogens were isolated from joint secretions around prosthesis of the patients with infections, among which Staphylococcus aureus and Staphylococcus epidermidis were dominant. CONCLUSIONThe survival status of prosthesis of the patients with peripheral infections of knee joint prosthesis who receive revision surgery is associated with the underlying diseases, exercise capacity and joint motion capabilities.The detection of the routine indexes such as PCT, CRP and ESR may effectively predict the survival status of prosthesis of the patients with peripheral infections of knee joint prosthesis after revision surgery.

     

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