摘要目的 探讨采用临时间隔物并二期手术治疗髋、膝关节慢性化脓性关节炎的疗效。方法 回顾性分析北京积水潭医院2017年1月至2019年12月期间诊断为髋关节或者膝关节化脓性关节炎并接受二期手术流程的22例病例资料，男12例，女10例；年龄34~74岁，平均(57.4±10.5)岁。其中髋关节化脓性关节炎患者7例，膝关节化脓性关节炎患者15例。采用Kaplan-Meier生存分析法计算患者的感染治疗成功率。比较手术前后髋关节患者Harris髋关节评分(Harris hip score，HHS)与膝关节患者美国特种外科医院(hospital for special surgery，HSS)膝关节评分，分析采用该方法的治疗效果。结果 1例膝关节患者在接受手术后10个月因内科疾病死亡；1例髋关节患者在术后9个月感染复发。5例患者仅接受一期手术治疗，但随访中未出现感染复发。17例患者完成二期手术，其中15例患者达到临床治愈。治疗成功率在2年时为89.5%(95%CI：64.1%~97.3%)。髋关节组患者HHS评分及膝关节组患者HSS评分均较术前明显提高。结果 采用临时间隔物并二期手术是治疗慢性髋、膝关节化脓性关节炎的有效方法，可以获得较高的感染控制率，同时可以有效地重建关节功能。
Abstract：Objective To investigate the efficacy and clinical effect of two-stage treatment protocol with temporary spacer for chronic septic arthritis of hip and knee.Methods From January 2017 to December 2019，22 patients diagnosed of septic arthritis of hip or knee joint underwent two-stage protocol in Beijing Jishuitan Hospital were analyzed retrospectively.12 male and 10 female patients were enrolled in this study with a mean age of (57.4±10.5)years old (range：34~74 years).Among these patients，there were 7 patients with hip chronic septic arthritis and 12 patients with knee chronic septic arthritis.The success rate of infection treatment was calculated by Kaplan-Meier survival analysis.The therapeutic effect was reported by comparison with preoperative and postoperative Harris hip score(HHS) of hip patients，and hospital for special surgery(HSS) knee scoreof knee patients.Results One knee patient died of medical disease 10 months after operation.One hip patient had recurrence of infection 9 months after operation.Five patients received only the first stage of the protocol，but there was no evidence of infection recurrence during follow-up.17 patients completed the protocol while 15 patients achieved success.The treatment success rate was 89.5% (95% confidence interval：64.1%~97.3%) at two years.HHS score in hip group and HSS score in knee group were significantly higher than those before operation.Conclusion Two-stage operation with temporary spacer is an effective treatment for chronic septic arthritis of hip and knee，with both high infection control rate and considerable joint function restore.
［1］Sharff KA，Richards EP，Townes JM.Clinical management of septic arthritis［J］.Curr Rheumatol Rep，2013，15(6)：332.
［2］Ross JJ.Septic arthritis of native joints［J］.Infect Dis Clin North Am，2017，31(2)：203-218.
［3］Hassan AS，Rao A，Manadan AM，et al.Peripheral bacterial septic arthritis：Review of diagnosis and management［J］.J Clin Rheumatol，2017，23(8)：435-442.
［4］Elsissy JG，Liu JN，Wilton PJ，et al.Bacterial septic arthritis of the adult native knee joint：A review［J］.JBJS Rev，2020，8(1)：e0059.
［5］Davis CM，Zamora RA.Surgical options and approaches for septic arthritis of the native hip and knee joint［J］.J Arthroplasty，2020，35(3S)：S14-S18.
［6］Bian T，Shao H，Zhou Y，et al.Tests for predicting reimplantation success of two-stage revision for periprosthetic joint infection：A systematic review and meta-analysis［J］.Orthop Traumatol Surg Res，2018，104(7)：1115-1123.
［7］Frank JM，Kayupov E，Moric M，et al.The mark coventry，MD，award：oral antibiotics reduce reinfection after two-stage exchange：A multicenter，randomized controlled trial［J］.Clin Orthop Relat Res，2017(475)：56-61.
［8］Fillingham YA，Della Valle CJ，Suleiman LI，et al.Definition of successful infection management and guidelines for reporting of outcomes after surgical treatment of periprosthetic joint infection：From the workgroup of the musculoskelet al infection society (MSIS)［J］.J Bone Joint Surg (Am)，2019，101(14)：e69.
［9］Mathews CJ，Weston VC，Jones A，et al.Bacterial septic arthritis in adults［J］.Lancet，2010，375(9717)：846-855.
［10］D'Angelo F，Monestier L，Zagra L.Active septic arthritis of the hip in adults：What's new in the treatment? A systematic review［J］.EFORT Open Rev，2021，6(3)：164-172.
［11］Warth LC，Hadley CJ，Grossman EL.Two-Stage treatment for total knee arthroplasty infection utilizing an articulating prefabricated antibiotic spacer［J］.J Arthroplasty，2020，35(3S)：S57-S62.
［12］Kildow BJ，Della-Valle CJ，Springer BD.Single vs 2-stage revision for the treatment of periprosthetic joint infection［J］.J Arthroplasty，2020，35(3S)：S24-S30.
［13］Xu C，Kuo FC，Kheir M，et al.Outcomes and predictors of treatment failure following two-stage total joint arthroplasty with articulating spacers for evolutive septic arthritis［J］.BMC Musculoskelet Disord，2019，20(1)：272.
［14］Zmistowski B，Karam JA，Durinka JB，et al.Periprosthetic joint infection increases the risk of one-year mortality［J］.J Bone Joint Surg (Am)，2013，95(24)：2177-2184.
［15］Boddapati V，Fu MC，Mayman DJ，et al.Revision total knee arthroplasty for periprosthetic joint infection is associated with increased postoperative morbidity and mortality relative to noninfectious revisions［J］.J Arthroplasty，2018，33(2)：521-526.
［16］Gomez MM，Tan TL，Manrique J，et al.The fate of spacers in the treatment of periprosthetic joint infection［J］.J Bone Joint Surg (Am)，2015，97(18)：1495-1502.
［17］Shen H，Wang QJ，Zhang XL，et al.Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis［J］.Orthopedics，2013，36(4)：e404-e408.
［18］Seo JG，Moon YW，Park SH，et al.Primary total knee arthroplasty in infection sequelae about the native knee［J］.J Arthroplasty，2014，29(12)：2271-2275.
晋公网安备 14010702070875号