在膝关节周围假肢关节感染的手术阶段之间转移的患者的治疗结果较差
Jonathon Florance1, Jerry Chang1, Patrick J Kelly1
1Department of Orthopaedic Surgery, Duke University, Durham, North Carolina.
The Journal of arthroplasty
|August 24, 2023
概括
在膝关节修复手术的第一阶段后,将患有周围假肢关节感染 (PJI) 的患者转移到新医院,会显著增加治疗失败率. 在一个机构的持续护理改善了全膝关节整形术 (PJI) 管理的结果.
科学领域:
- 整形外科手术 整形外科手术
- 传染病管理 传染病管理
背景情况:
- 在全膝关节整形术 (TKA) 后的周围假肢关节感染 (PJI) 通常需要两阶段的修复手术.
- 在外部机构初步PJI管理后转移到三级中心的患者的结果存在有限的数据.
研究的目的:
- 为了比较PJI的两阶段TKA修订的成功率,当第一阶段在外部医院进行,而不是在单一的三级中心进行持续管理时.
- 确定影响转移PJI患者治疗成功的因素.
主要方法:
- 对25名带有抗生素间隔剂的膝盖PJI患者的回顾性审查和至少2年的随访 (2014-2021年).
- 匹配的队列分析将转移的患者与在同一机构接受两阶段的患者进行比较.
- 通过修改的Delphi标准定义的成功 (没有重新手术或再感染).
主要成果:
- 与持续治疗组 (84%) 相比,转移组的治疗成功率明显较低 (40%).
- 转移的患者在阶段之间经历了更多的手术 (44% vs. 8%) 和更长的阶段间持续时间 (20.1 vs. 7.0周).
- 在所有治疗阶段,转移组的整体手术数量更高.
结论:
- 在修复手术阶段之间转移患有PJI的患者与更高的治疗失败率有关.
- 建议在一个机构中持续管理PJI,以改善手术结果.
- 早期转诊和综合护理途径对于TKA中成功的PJI管理至关重要.
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