对于急性周围假肢关节感染的双重DAIR协议:15年的机构经验
Saad Tarabichi1, Jens T Verhey1, Jack M Haglin1
1Department of Orthopaedic Surgery, Mayo Clinic Arizona, Phoenix, Arizona.
The Journal of arthroplasty
|May 25, 2025
概括
双重脱bridement,抗生素和植入物保留 (DAIR) 程序在治疗急性周围假肢关节感染 (PJI) 中取得了成功. 然而,修复关节整形术和除菌期间的阳性培养预测治疗失败.
科学领域:
- 整形外科手术 整形外科手术
- 传染性疾病 传染性疾病
- 生物医学工程 生物医学工程
背景情况:
- 急性周围假肢关节感染 (PJI) 的治疗具有挑战性.
- 使用带有抗生素的骨质水泥珠的双重脱bridement,抗生素和植入物保留 (DAIR) 协议是急性PJI的一个有希望的方法.
- 了解双DAIR协议的结果和失败预测因素至关重要.
研究的目的:
- 评估急性PJI的双DAIR协议的临床结果.
- 为了确定双 DAIR 程序后治疗失败的独立预测因素.
主要方法:
- 对患有急性PJI (≤28天) 患者的回顾性研究,接受双重DAIR治疗.
- 基于2013年肌肉骨感染学会标准的急性PJI诊断.
- 最少1年的随访;治疗失败定义为重新手术,与PJI相关的死亡率或持久感染.
主要成果:
- 分析了128名患者 (69个膝盖,59个部),平均随访时间为4.8年.
- 感染初级的治疗成功率为86.1%,感染修订的治疗成功率为71.4%.
- 修复关节整形术 (OR 7.6),急性血源性PJI (OR 7.1) 和第二次脱bridement (OR 5.0) 的积极培养是失败的独立预测因素.
结论:
- 双DAIR协议显示了急性PJI的高成功率,其中86.1%的初级和71.4%的复查病例没有感染.
- 修复关节整形术,急性血源性PJI和阳性手术内培养是治疗失败的重要预测因素.
- 这些发现有助于患者选择和治疗急性PJI治疗的治疗策略.
相关概念视频
01:28Acute Pyelonephritis II: Diagnostic Studies and Management
52
Introduction:For diagnosing acute pyelonephritis, a comprehensive patient history is collected to identify symptoms such as dysuria, frequent or urgent urination, flank pain, or costovertebral angle (CVA) tenderness that may suggest a kidney infection.Physical ExaminationDuring the physical examination, CVA tenderness is assessed. This involves gentle percussion over the costovertebral angle, where tenderness often indicates a kidney infection.Diagnostic TestsUrinalysis: Used to identify white...
52
01:22Healthcare Associated Infections II: Preventive Measures
2.8K
Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
2.8K
01:27Acute Pyelonephritis I: Introduction
72
Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
72