【2017年整理】假体关节相关感染.doc

假体关节相关感染 A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. The pain has not responded to nonsteroidal anti-inflammatory drugs. Physical examination reveals a sinus tract overlying her left hip. Her leukocyte count is 8000 per cubic millimeter, and the C-reactive protein (CRP) level is 15.5 mg per liter. A radiograph shows loosening of the prosthesis at the bone–cement interface. Synovial-fluid aspirate shows 15×103 cells per cubic millimeter (89% neutrophils); cultures of an aspirate from the hip grow Staphylococcus epidermidis. How should her case be managed? 1名62岁女性骨性关节炎患者，左侧THA术后8个月，左髋渐进性疼痛并向腹股沟放射7个月。服用非甾类抗炎药疼痛无缓解。查体示左髋有一窦道形成。白细胞计数为8000个/mm3，C-RP为15.5mg/L。放射线检查示假体和骨水泥界面有松动。关节液检查示15X103个细胞/mm3，中性粒细胞比例为89％；关节炎培养示为表皮葡萄球菌阳性。该如何对这一病例进行处理？ The Clinical Problem The numbers of primary total hip and total knee arthroplasties have been increasing over the past decade, with nearly 800,000 such procedures performed in the United States in 2006 (Fig. 1A).1 Procedures to replace the shoulder, elbow, wrist, ankle, temporomandibular, metacarpophalangeal, and interphalangeal joints are less commonly performed. 临床问题： 过去10年间，行首次髋膝关节置换的病例数有了大幅的增长，到2006年美国约进行了800000例此类手术。而行肩、肘、腕、踝、颞下颌、掌指和指间关节置换则少见的多。 Prosthetic joints improve the quality of life, but they may fail, necessitating revision or resection arthroplasty. Causes of failure include aseptic loosening, infection, dislocation, and fracture of the prosthesis or bone. Infection, although uncommon, is the most serious complication, occurring in 0.8 to 1.9% of knee arthroplasties3-5 and 0.3 to 1.7% of hip arthroplasties.5-7 The frequency of infection is increasing as the number of primary arthroplasties increases (Fig. 1B).2 Patient-related risk factors for infection include previous revision arthroplasty or previous infection associated with a prosthetic joint at the same site, tobacco abuse