髋膝关节置换术后失败的原因分析及感染的微生物学及药敏分析-外科学(骨科)专业论文.docx

解放军医学院博士学位论文 解放军医学院博士学位论文 万方数据 万方数据 作 者：孙长鲛 学科专业：外科学（骨科） 导 师：王 岩 髋、膝关节置换术后失败的原因分析及感染的微生物学及药 敏分析 中文摘要 目的: 研究国内髋、膝关节置换术后失败的原因和感染的微生物及药敏情况 方法: 回顾性分析我院 2007 年 1 月至 2012 年 12 月来我院行髋、膝关节翻修手术患 者的失败原因并对感染病例进行微生物学和药敏分析。 结果:髋关节置换失败原因主要为为松动、感染、脱位、翻修术后依次为感染、脱位、 无菌性松动。膝关节初次置换的失败原因依次为感染，松动，膝关节僵直粘连，翻修 术后依次为感染，僵直粘连），松动，伸膝装置问题。凝固酶阴性葡萄球菌是检出比 例最高的菌株，其次是金黄色葡萄球菌。耐甲氧西林葡萄球菌的检出比例较高, 抗生 素药敏情况提示：头孢唑啉和头孢呋辛对凝固酶阴性葡萄球菌和耐甲氧西林葡萄球菌 耐药情况严重。 结论：国内髋关节初次置换失败的最常见原因分别是无菌性松动和感染， 翻修术后 为感染和脱位。膝关节初次置换失败的最常见原因分别是感染和无菌性松动， 翻修 术后为感染和无菌性松动。经验型用药可以选用本研究推荐的抗生素，应当根据药敏 结果及时调整抗生素。 1 Causes of failure after total hip and knee arthroplasty and analysis of microbiology and antibiotic susceptibility in prosthetic infections Abstract Objective:To identify the causes of failures after total hip and knee arthroplasty in China Methods : We retrospectively reviewed the causes of failures after total hip and knee arthroplasty among patients between January 2007 and December 2013. Then investigated the microbiological etiology of prosthetic infections who were treated with two-staged revision and analyze antibiotic susceptibility of bacteria Results: The main reasons of failures of primary THA were aseptic loosening ,infection, and dislocation, revision THA were infection,dislocation and aseptic loosening, The main reasons of failures of primary TKA were infection ,aseptic loosening, ,arthrofibrosis, revision TKA were infection，arthrofibrosis and aseptic loosening. Coagulase-negative staphylococci was the most common causative organism of infection,followed by Staphylococcus aureus.The proportion of isolated methicillin-resistant Staphylococcus is high, The results of antibiotic susceptibility showed cefazolin and cefuroxime were poorly susceptible to Coagulase negative staphylococci and Methicillin-resistant Staphylococcus. Conclusion:The major cause of primary THA in China were aseptic loosening and infection. revision THA was infection and dislocation. The major cause of primary TKA were infection and aseptic loose