摘要
目的探讨人工关节旷置术联合硫酸钙抗生素颗粒在治疗膝关节真菌性假体周围感染的临床效果。方法回顾性分析2019年1月至2022年12月因膝关节真菌性假体周围感染在郑州大学第一附属医院接受人工关节旷置术联合硫酸钙抗生素颗粒植入术的13例患者的临床资料。其中,男性6例,女性7例,年龄(67.9±11.2)岁。所有患者均接受人工膝关节旷置术,术中关节腔内植入含有两性霉素B的硫酸钙颗粒,术后给予抗真菌药物治疗。所有患者均在术前抽取关节液进行真菌培养及药敏分析。术后定期随访感染治疗情况、关节活动度(ROM)、患者C反应蛋白(CRP)和红细胞沉降率(ESR)的变化情况,并比较手术前后膝关节功能评分。结果13例患者随访时间24~65个月,平均47.2个月。11例患者经过1次治疗后感染得到控制,至末次随访未出现感染复发,2例患者在随访过程中感染复发,经过再次治疗后感染得到控制,1次治疗感染控制率为84.62%。微生物培养结果显示近平滑念珠菌5例、光滑念珠菌3例、白念珠菌2例,念珠菌占比76.92%。ROM由旷置术前的(48.57±20.69)°提高至末次随访时的(94.29±22.01)°,美国特种外科医院膝关节评分(HSS)由旷置术前的(44.93±8.58)分提高至末次随访时的(87.21±6.17)分。末次随访时所有患者均无感染复发症状,ESR与CRP均在正常范围内。结论人工关节旷置术联合硫酸钙抗生素颗粒治疗膝关节真菌性假体周围感染可获得较理想的临床效果,感染控制率较高,且患膝屈伸功能改善明显。
Objective To investigate the effect of resection arthroplasty combined with calcium sulfate antibiotic granules for knee fungal periprosthetic joint infection.Methods From January 2019 to December 2022,the date of 13 patients[6 males and 7 females,age of(67.9±11.2)years]with knee fungal fungal periprosthetic joint infection had undergone resection arthroplasty combined with calcium sulfate antibiotic granules implantation was retrospective analysis.Calcium sulfate granules containing amphotericin B were implanted into the joint cavity during operation,and antifungal drugs were administered postoperatively.Synovial fluid was collected for microorganism culture and analysis of drug sensitivity preoperatively.Range of motion(ROM),C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),and Hospital for Special Surgery knee-rating scale(HSS)score were regularly evaluated during follow-up.Results The follow-up period ranged from 24 to 65 months and the mean of follow-up time were 47.2 months.The infection of 11 patients was cured after once treatment,with no recurrence occurring up to the last follow-up.However,two patients experienced infection recurrence during the follow-up period,with the infection being cured after re-treatment.The infection recovery rate of once treatment was 84.62%.Five patients were infected with Candida parapsilosis,three with Candida glabrata,and two with Candida albicans.Candida accounted for infection in 76.92%of patients.ROM was improved from(48.57±20.69)°to(94.29±22.01)°.HSS score was increased from 44.93±8.58 preoperatively to 87.21±6.17 at the last follow-up.At the last follow-up,no patients had any symptoms of recurrence of infection,and ESR and CRP were within the normal ranges.Conclusion Resection arthroplasty combined with calcium sulfate antibiotic granules can achieve a satisfactory therapeutic effect for knee fungal fungal periprosthetic joint infection,with a higher rate of infection recovery and more significant improvement of knee function.
作者
张少坤
葛会安
陆世涛
刘永一
许建中
ZHANG Shaokun;GE Hui’an;LU Shitao;LIU Yongyi;XU Jianzhong(Department of Osteology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)
出处
《河南医学研究》
2025年第16期2895-2900,共6页
Henan Medical Research
基金
河南省医学科技攻关(联合共建)项目(LHGJ20190174)。
关键词
人工关节旷置术
真菌
膝关节
假体周围感染
硫酸钙
resection arthroplasty
fungal infection
knee joint
periprosthetic infection
calcium sulfate
作者简介
通信作者:张少坤,E-mail:378002372@qq.com。
