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1、假体关节相关感染A62-year-oldwomanwithosteoarthritispresentswitha7-monthhistoryofprogressivelyworseninglefthippainradiatingtothegroin,8monthsafterundergoingtotalleft-hiparthroplasty.Thepainhasnotrespondedtononsteroidalanti-inflammatorydrugs.Physicalexaminationrevealsasinustractoverlyingherleft
2、hip.Herleukocytecountis8000percubicmillimeter,andtheC-reactiveprotein(CRP)levelis15.5mgperliter.Aradiographshowslooseningoftheprosthesisatthebone–cementinterface.Synovial-fluidaspirateshows15×103cellspercubicmillimeter(89%neutrophils);culturesofanaspiratefromthehipgrowStaphylococcusep
3、idermidis.Howshouldhercasebemanaged?1名62岁女性骨性关节炎患者，左侧THA术后8个月，左髋渐进性疼痛并向腹股沟放射7个月。服用非甾类抗炎药疼痛无缓解。查体示左髋有一窦道形成。白细胞计数为8000个/mm3，C-RP为15.5mg/L。放射线检查示假体和骨水泥界面有松动。关节液检查示15X103个细胞/mm3，中性粒细胞比例为89％；关节炎培养示为表皮葡萄球菌阳性。该如何对这一病例进行处理？TheClinicalProblemThenumbersofprimarytotalhipandtotalkneearthroplastie
4、shavebeenincreasingoverthepastdecade,withnearly800,000suchproceduresperformedintheUnitedStatesin2006(Fig.1A).1Procedurestoreplacetheshoulder,elbow,wrist,ankle,temporomandibular,metacarpophalangeal,andinterphalangealjointsarelesscommonlyperformed.临床问题：过去10年间，行首次髋膝关节置换的病例数有了大幅的增长，到2006年
5、美国约进行了800000例此类手术。而行肩、肘、腕、踝、颞下颌、掌指和指间关节置换则少见的多。Prostheticjointsimprovethequalityoflife,buttheymayfail,necessitatingrevisionorresectionarthroplasty.Causesoffailureincludeasepticloosening,infection,dislocation,andfractureoftheprosthesisorbone.Infection,althoughuncommon,isthemostseriousc
6、omplication,occurringin0.8to1.9%ofkneearthroplasties3-5and0.3to1.7%ofhiparthroplasties.5-7Thefrequencyofinfectionisincreasingasthenumberofprimaryarthroplastiesincreases(Fig.1B).2Patient-relatedriskfactorsforinfectionincludepreviousrevisionarthroplastyorpreviousinfectionassociatedwitha
7、prostheticjointatthesamesite,tobaccoabuse,obesity,rheumatoidarthritis,aneoplasm,immunosuppression,anddiabetesmellitus.Surgicalriskfactorsincludesimultaneousbilateralarthroplasty,alongoperativetime(>2.5hours),andallogeneicbloodtransfusion,andpostoperativeriskfactorsincludewoundhealingc
8、ompli
