摘要
目的探讨聚维酮碘间断灌洗治疗人工关节置换术后早期假体周围感染的临床疗效。方法2014年9月至2017年9月采用聚维酮碘间断灌洗治疗人工股骨头置换术、全髋关节置换术和全膝关节置换术后早期假体周围感染患者6例。均未行清创手术,聚维酮碘灌洗在床旁操作。广泛消毒铺巾后,用血管钳探查切口是否存在与假体相通的窦道和脓性分泌物,取标本进行细菌培养,分离周围重要组织并保护。在血管钳保护下,注入质量浓度为50 g/L的聚维酮碘溶液10 ml进行关节腔灌洗。24 h后重复操作,每天1次,直至创面新鲜、无脓性分泌物溢出、渗出减少、两次以上关节液细菌培养阴性。停止灌洗后继续常规换药,直至伤口愈合。随访观察6例患者全身和局部感染控制情况,包括体温、伤口红肿、压痛、波动、渗出及窦道。出院后第1、3、6、12、24个月随访,复查血常规、红细胞沉降率、C-反应蛋白和肝肾功能,摄患侧关节标准X线片,观察假体下沉、松动、骨溶解、骨膜反应等征象。采用Harris髋关节评分或美国膝关节协会评分(Knee Society Score,KSS)及疼痛视觉模拟评分(visual analogue score,VAS)评估髋、膝关节功能。结果6例平均灌洗(12.7±5.7)次(范围6~18次)。出院后随访(42.1±13.4)个月(范围24~60个月)。末次随访时6例患者切口愈合均良好,无红肿渗出,无全身和局部感染征象;影像学检查未提示关节假体周围存在骨质溶解、假体松动及骨膜反应等征象。6例均未见感染复发。出院后第1、3、6、12、24个月疼痛VAS评分均低于术前的(4.67±0.82)分(F=24.79,P<0.001);5例髋关节患者各随访时间点Harris评分分别为(70.00±8.92)分、(76.40±7.23)分、(81.40±6.07)分、(82.80±4.87)分、(83.20±5.07)分,差异无统计学意义(P>0.05),均高于术前的(22.40±12.74)分(F=43.74,P<0.001);1例全膝关节置换术患者膝关节功能较术前显著改善,术前及出院后第1、3、6、12、24个月时KSS评分分别为50、75、80、88、90、90分。治疗期间无医源性损伤发生,无深静脉血栓形成、肺栓塞、严重肝肾功能损害及患者死亡。结论对初次人工髋膝关节置换术后早期假体周围感染采用再次手术清创治疗存在明确禁忌或患者拒绝再次手术时,聚维酮碘间断灌洗是一种可选择的治疗方法。
Objective To investigate the clinical effects of intermittent irrigation with povidone iodine for early postoperative infections of prosthetic joint.Methods From September 2014 to September 2017, a total of 6 patients with early postoperative infections of prosthetic joint were analyzed retrospectively. They underwent one of three types of orthopedic surgery, namely femoral head replacement (FHR), total hip arthroplasty (THA) or total knee arthroplasty (TKA). These patients were treated with intermittent irrigation at the bedside instead of debridement. After extensive disinfection, the presence of pus and sinuses communicating with the prosthesis were detected with vascular forceps. Then, the specimens were taken for bacterial culture. Under the protection of the forceps, a needle was entered the joint cavity. Povidone iodine solution (50 g/L, 10 ml) was injected into the joint for irrigation. The intervention was repeated once every day. When the wound was fresh, no pus was observed with negative bacterial cultures for more than twice. The irrigation operation was stopped followed by dressing change until the wound heals. During the follow-up, six patients were observed for systemic and local infections, including body temperature, swelling, tenderness, fluctuations, exudation and sinus. At 1, 3, 6, 12 and 24 months after discharge, the routine blood tests, erythrocyte sedimentation rate, C-reactive protein, liver and kidney function were tested. X-rays of the affected joints were examined to record the signs of infection such as prosthesis subsidence, loosening, osteolysis, and periosteal reaction. Harris/KSS joint function score and visual analogue score (VAS) were used to evaluate the hip or knee joint function. The iatrogenic injuries and complications were also recorded.Results The follow-up duration was 42.1±13.4 months (24-60 months). Each case has been irrigated for 12.7±5.7 times (6-18 times). At the last follow-up, all patients achieved satisfied incision healing. No swelling, exudation, systemic and local infection was observed without signs of infection such as osteolysis, loosening of prosthesis and periosteal reaction in radiographs. The VAS scores at 1, 3, 6, 12, 24 months after discharge were all lower than those at the preoperative (4.67±0.82) (F=24.79, P<0.001). The Harris scores of the 5 hip patients at 1, 3, 6, 12, 24 months after discharge were 70.00±8.92, 76.40±7.23, 81.40±6.07, 82.80±4.87 and 83.20±5.07, respectively. No statistical difference was found between them (P>0.05). However, they were all higher than the preoperative Harris score (22.40±12.74) (F=43.74, P<0.001). In a patient with TKA, the knee function was significantly improved after discharge. Before surgery and 1, 3, 6, 12, 24 months after discharge, the KSS scores were 50, 75, 80, 88, 90 and 90 respectively. No iatrogenic injuries, serious complications such as deep vein thrombosis, pulmonary embolism, severe liver/kidney damage or deaths were observed.Conclusion When debridement is contraindicated or refused by patients, intermittent irrigation with povidone iodine may be a treatment method for patients with early postoperative infections of prosthetic joint.
作者
王利宏
单军标
周方伦
李勇
徐国红
Wang Lihong;Shan Junbiao;Zhou Fanglun;Li Yong;Xu Guohong(Department of Orthopaedics,Dongyang Hospital of Wenzhou Medical University,Dong Yang 322100,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2020年第13期840-847,共8页
Chinese Journal of Orthopaedics
基金
浙江省自然科学基金基础公益研究计划项目(LGF18H060001)。
关键词
聚维酮碘
假体相关感染
灌洗疗法
Povidone iodine
Prosthesis-related infections
Therapeutic irrigation
