摘要
目的探讨采用封闭式负压引流术(vacuum sealing drainage,VSD)结合病灶清创治疗人工髋、膝关节置换术后深部感染的方法和疗效。方法 2006年9月-2010年5月,收治13例人工关节置换术后深部感染患者。男5例,女8例;年龄56～78岁,平均62.5岁。置换术后7 d～1年2个月发生感染,中位时间14 d;发生感染至入院时间为8 d～4年6个月,中位时间21 d。均见脓性或脓血性分泌物,5例形成窦道,8例切口、引流口未愈合。分泌物引流口或窦道口皮肤缺损范围为5 mm×3 mm～36 mm×6 mm;分泌物引流通道或窦道深度为21～60 mm。11例取组织行病理检查,提示10例为急性或慢性化脓性感染急性发作,1例为结核。6例取分泌物培养,提示5例金黄色葡萄球菌阳性,1例为阴性。彻底清创后,10例行白天冲洗和晚上持续VSD治疗;3例仅持续VSD治疗。结果 1例人工全髋关节翻修术者VSD治疗时出血较多,停止负压吸引并加压包扎,第3天再次行VSD无大量出血。患者均获随访,随访时间1年～4年5个月,平均2年11个月。10例患者经VSD治疗后7～75 d感染控制,平均43 d;假体均保留,无感染复发,创面愈合良好,疼痛缓解,关节功能良好。1例因负压区疼痛过敏难以忍受拒绝VSD治疗,感染控制无效行大腿中上段截肢;1例感染结核疗效不明显,取出假体后采用骨水泥填塞临时膝关节融合治疗;1例VSD治愈后9个月感染再复发,取出假体旷置、VSD治疗3周,1年4个月未复发。结论 VSD结合病灶清创术使深部创面引流充分,可促进创面愈合,降低感染复发率,最大程度保留假体。
Objective To investigate the method and effectiveness of vacuum sealing drainage（VSD） combined with debridement for treatment of deep infection after hip or knee replacement.Methods Between September 2006 and May 2010,13 cases of deep infection after joint replacement surgery were treated,including 5 males and 8 females with an average age of 62.5 years（range,56-78 years）.Infection occurred at 7 days to 1 year and 2 months（median,14 days） after joint replacement surgery.The time from infection to admission was 8 days to 4 years and 6 months（median,21 days）.Purulent secretion with or without blood were observed in all patients;sinus formed in 5 cases;and unhealing of incision or drainage opening disunion were observed in 8 cases.The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm;the depth of drainage tunnel or sinus was 21-60 mm.The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases,and tuberculosis in 1 case.In 6 cases of secretion culture,Staphylococcus aureus was isolated from 5 cases.After thorough debridement,wound irrigation was performed during the day and VSD during the night in 10 cases.VSD was merely performed in 3 cases.Results In 1 case after revision total hip arthroplasty,the wound bled profusely with VSD,then VSD stopped and associated with compression bandage,VSD proceeded again 3 days later with no heavy bleeding.All the patient were followed up 1 year to 4 years and 5 months（mean,2 years and 11 months）.Infection were controlled 7-75 days（mean,43 days） after VSD in 10 cases.In these cases,prosthesis were reserved,no recurrent infection was observed,wound were healed,limb function were reserved.VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site,infection control was failed and amputation at the thigh was proceeded.The effect was not evident in 1 case with tuberculosis infection,then the prosthesis was removed and arthrodesis was proceeded followed by complete union.In 1 case,infection was cured with VSD,recurrent infection happened after 9 months,antibiotic-impregnated cement spacer was used at end,and no recurrence was observed 1 year and 4 months later.Conclusion VSD combined with debridement can drainage deep infection sufficiently,promote wound healing,reduce recurrent infection rate,maximize the possibility of prosthesis preservation.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2011年第11期1319-1322,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
人工关节置换术
深部感染
封闭式负压引流术
清创
Artificial joint replacement Deep infection Vacuum sealing drainage Debridement
