膝关节置换术后假体周围感染课件

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1、InfectionClinicalInfectiousDiseases2013;56(1):1–10PreoperativeEvaluationRecommendations1-81.SuspectPJIinpatientswithanyofthefollowing(B-III):可疑PJI窦道或持续的伤口引流术后任何时间段内关节的急性疼痛发作或慢性关节疼痛，特别是没有疼痛间歇的术后伤口愈合出现问题，或既往浅表或深部感染病史2.EvaluationofthepatientwithapossiblePJIshouldincludeathoroughhistoryandphysi

2、calexamination(C-III).病史采集和体格检查假体类型植入时间关节的既往手术史伤口愈合情况远隔感染近期临床症状药物过敏及耐药既往或近期穿刺或术中病原学检查结果抗生素治疗经过3.AtestforsedimentationrateorC-reactiveprotein(CRP)shouldbeperformedinallpatientswithasuspectedPJIwhenthediagnosisisnotclinicallyevident.ESR&CRP血沉、CRP检查4.Aplainradiographshouldbeperformedinallpati

3、entswithsuspectedPJI(A-III).5.AdiagnosticarthrocentesisshouldbeperformedinallpatientswithsuspectedacutePJIunlessthediagnosisisevidentclinicallyandsurgeryisplannedandantimicrobialscanbesafelywithheldpriortosurgery.Arthrocentesisisalsoadvisedinpatientswithachronicpainfulprosthesisinwhomtherei

4、sanunexplainedelevatedsedimentationrateorCRPlevel(A-III).怀疑急慢性PJI，行关节穿刺术包括细胞计数和分类，需氧/厌氧培养6.InPJIwherethepatientismedicallystable,withholdingantimicrobialtherapyforatleast2weekspriortocollectionofsynovialfluidforcultureincreasesthelikelihoodofrecoveringanorganism(B-III).在病情允许的情况下，在细菌学检查前停止

5、使用抗生素2周以上7.Bloodculturesforaerobicandanaerobicorganismsshouldbeobtainediffeverispresent,thereisanacuteonsetofsymptoms,orifthepatienthasaconditionorsuspectedconditionorconcomitantinfectionorpathogen(egStaphylococcusaureus)thatwouldmakethepresenceofabloodstreaminfectionmorelikely(B-III).患者发烧，出

6、现急性感染症状，或伴随感染，可能出现血源性感染时，行血培养检查（需氧/厌氧）8.Imagingstudiessuchasbonescans,leukocytescans,magneticresonanceimaging,computedtomography,andpositronemissiontomographyscansshouldnotberoutinelyusedtodiagnosePJI(B-III).不常规使用骨扫描、CT、MRI、断层扫描来诊断PJIIntraoperativeDiagnosisofPJIRecommendations9-119.Intraoper

7、ativehistopathologicalexaminationofperiprosthetictissuesamplesisahighlyreliablediagnostictestprovidedthatapathologistskilledininterpretationofperiprosthetictissueisavailable.Itshouldbeperformedatthetimeofrevisionprostheticjointsurgery,whenavailable