全膝关节置换术后感染的预防和治疗.doc

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1、InfectionFollowingTotalKneeArthroplasty:PreventionandManagement全膝关节置换术后感染的预防和治疗KevinL.Garvin,MD,andBeauS.Konigsberg,MDAnInstructionalCourseLecture,AmericanAcademyofOrthopaedicSurgeonsPeriprostheticjointinfectionisoneofthemostformidablechallengesforarthroplastysurgeons.

2、Physiciansandscientistshaveworkeddiligentlytolowertheincideneeofinfectionsaroundprostheticjoints,butthepercentageofpatientswhodevelopaninfectionafterprimarytotalkneereplacementremainsintherangeof0.4%to2%1・3.Medicaredataindicatethattherateofperiprostheticinfectionwithin

3、thefirsttwoyearsafterkneearthroplastyis1.55%・Theinfectionrateinthefollowingtwototenyearsisanadditional0.46%4,5・关节假体周围感染是关节外科医师所面临的最严峻的挑战z—。尽管医生和科学家们一致努力降低关节假体周围感染的发病率，但初次金膝关节置换术后发生感染的患者的比例仍冇0.4%・2%。医疗数据显乐，关节假体周用感染在膝关节置换术后前2年的发生率为1.55%,而之后的2-10年的发生率増加0.46%.Whiletheperce

4、ntageofprosthetickneesthatareassociatedwithinfectionislow,thenumberswillincreasewiththegrowingnumberoftotalkneereplacements・Kurtzetal.projectedthatthedemandforprimarykneearthroplastywillgrowby673%,from450,000in2005to3.48millionin20306.If2%ofthe3.48millionpatientsdevelo

5、paninfectionwithinthefirstyearafterthekneearthroplasty,asmanyas69,000patientsmaybetreatedforperiprosthetickneeinfectioneachyear.Thisgroupdoesnotineludepatientswhodevelopaninfectionmorethanoneyearafterthesurgeryorafterarevisiontotalkneearthroplasty.Theburdenandcomplexit

6、yarealsoincreasingbecauseofthenumberofresistantpathogens.然而与膝关节假体相关的感染的发生率较低，感染的例数随若全膝关节置换的数最增加HU增加。Kurtz等曾经预测需要厅初次全膝关节置换的病例数将会从2005年的450.000例增加到2030年的348丿j例.增加673%。如果348力例患者有2%在膝关节置换术后第1年发生感染，毎年人约会有69,000例患者会因膝关节假体周鬧感染l(UfflfT治疗。这些还不包括术后1年以后或者膝关节翻修术后发生感染的患者。因为耐药菌的产生，患

7、者的负担和疾病的复杂性也相应増加了。Staphylococcusaureusaccountsforthemajorityofperiprostheticjointinfections.InfectionscausedbymethicillirvresistantStaphylococcusaureus(MRSA)areespeciallydifficulttotreat7-9.TheStaphylococcusinfectionsmaybeacquiredinthehospital,butsomepatientsareknownca

8、rriersofStaphylococcusaureusandinfeetthemselves10,11-Patientswhoarecarrierscanbescreenedanddecolonizationcanbecarried