两阶段策略中的间隔器对于周围假肢感染的两阶段策略
Cécile Batailler1, Nicolas Cance2, Sébastien Lustig1
1Service de Chirurgie Orthopédique et Médecine du Sport, Centre d'Excellence FIFA, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France; Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, 69622 Villeurbanne, France.
Orthopaedics & traumatology, surgery & research : OTSR
|November 28, 2024
概括
在感染植入物的两阶段修复中,关节间隔器提供抗生素并保持关节空间. 最佳的间隔器设计和抗生素选择对于成功的再植入和最小化并发症至关重要.
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
- 生物材料科学 生物材料科学
背景情况:
- 两阶段修复手术是感染骨科植入物的常见方法.
- 关节间隔器在输送抗生素和在手术阶段之间保持关节功能方面发挥着至关重要的作用.
- 周围假肢关节感染的有效管理需要仔细考虑抗生素特性和间隔器特性.
研究的目的:
- 审查用于水泥间隔器的抗生素的基本特征,以实现最佳的关节扩散.
- 概述了感染植入物的两阶段修复手术所涉及的程序步骤.
- 为了分类可用的关节间隔器类型,并讨论相关的并发症.
主要方法:
- 文献综述侧重于抗生素特性,两阶段修订技术和间隔器类型.
- 对水泥间隔器抗生素要求的分析 (耐热性,溶解性,稳定性).
- 基于关节和应用,将间隔器分为静态和动态类型.
主要成果:
- 抗生素必须具有耐热性,水溶性,在水泥中化学稳定性;青胺和胺是首选的.
- 两阶段的修复包括移除植入物,插入间隔器,并在6周到3个月后重新植入.
- 静态间距器用于骨缺陷/软组织问题;动态间距器保留关节功能. 常见的并发症包括间隙位移和断裂.
结论:
- 选择合适的抗生素和间隔器生物机械/细菌学性质对于有效性和并发症减少至关重要.
- 系统性抗生素治疗至少3个月,建议在周围假肢关节感染.
- 根据关节和患者的因素,必须仔细考虑间隔器类型 (静态或动态).
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