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[人工关节周围感染]

[Periprosthetic infection].

作者信息

Perka C, Haas N

机构信息

Centrum für Muskuloskeletale Chirurgie, Klinik für Orthopädie und Klinik für Unfall- und Wiederherstellungchirurgie, Charité-Universitätsmedizin Berlin, Campus Virchow-Klinikum, Charitéplatz 1, Berlin, Germany.

出版信息

Chirurg. 2011 Mar;82(3):218-26. doi: 10.1007/s00104-010-2014-3.

Abstract

Periprosthetic infections represent the most feared complications in orthopedic surgery. Frequently, the substantial challenges result more from a delayed diagnosis and an inadequate therapy than from the infection itself. The guiding symptom is pain. The determination of C-reactive protein (CRP) and the blood sedimentation rate (BSR) is the basic screening test for infection while joint aspiration is commonly used to confirm the diagnosis. Infection treatment with implant preservation is only promising and justifiable in the early postoperative infection period. The current concept of infection treatment consists of a two-stage revision with 6-8 weeks implant-free interval and an accompanying antibiotic therapy. The one-stage revision is the patient-friendliest procedure but requires strict prerequisites which may not be given in a number of cases. The reported mean success rates range from 80-100% with the respective therapeutic procedures. However, there is no single evidenced-based therapeutic concept throughout the whole course of treatment but frequently a various number of individual modifications. Nevertheless, a clear strategy in treatment planning using objective criteria without subjective decisions and emotions is essential for the success of therapy. If the healing rate falls under 80% the applied concept must be reconsidered.

摘要

假体周围感染是骨科手术中最令人担忧的并发症。通常,巨大的挑战更多源于诊断延迟和治疗不当,而非感染本身。主要症状是疼痛。C反应蛋白(CRP)和血沉(ESR)的测定是感染的基本筛查试验,而关节穿刺常用于确诊。在术后早期感染阶段,保留植入物进行感染治疗才有希望且合理。目前的感染治疗理念包括两阶段翻修,无植入物间隔6 - 8周,并辅以抗生素治疗。一期翻修是对患者最友好的手术方式,但需要严格的前提条件,而在许多情况下可能无法满足。报道的各种治疗方法的平均成功率在80% - 100%之间。然而,在整个治疗过程中,没有单一的循证治疗理念,而是经常有多种个体化的调整。尽管如此,在治疗规划中使用客观标准,避免主观决策和情绪,制定明确的策略对于治疗成功至关重要。如果愈合率低于80%,就必须重新考虑所应用的理念。

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