利福平联合用药结合保留假体清创术治疗人工关节初期感染

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摘要目的探讨在人工关节置换术后初期低毒性感染中应用保留假体清创术结合利福平联合用药的有效性及安全性。方法回顾性分析我院自2010年2月至2016年2月收治的12例人工关节置换术后初期低毒性感染患者。其中男4例，女8例；年龄65～75岁，平均70岁；全髋置换术后感染4例，全膝置换术后感染8例。感染出现时间为置换术后的7 d～1个月。对3例窦道形成和3例出现急性感染表现的患者行保留假体清创术，术后依据药敏结果使用抗生素1周，然后采用利福平300 mg联合环丙沙星500 mg口服，每天2次，持续6个月。余6例依据药敏结果行利福平联合用药治疗，若效果欠佳则行保留假体清创术后再采用利福平联合用药治疗。所有患者均获随访，随访时间6～27个月，平均24个月。随访观察内容包括：血细胞计数、血沉、C反应蛋白、肝功能、影像学资料、关节活动度及关节功能。治愈标准：无临床感染征象，血沉小于20 mm/h，C反应蛋白小于5 mg/L或显著降低且趋于正常，关节疼痛减轻或消失，关节活动度良好。结果 1例患者治疗过程出现假体松动行关节翻修术后治愈。其余11例患者均完成6个月疗程的治疗，9例获得成功，2例失败，总治愈率81.8％。结论保留假体清创术结合利福平联合用药在人工关节置换术后初期低毒性染治疗中具有一定的临床疗效和安全性，为人工关节置换术后初期低毒性感染的治疗提供一定的参考价值。

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关键词 ：利福平, 环丙沙星, 感染, 清创术

Abstract：Objective To explore the effectiveness and safety of prothesis retention debridement and rifampicin in early low toxicity infection after arthroplasty.Methods We made a retrospective analysis on 12 patients with an initial low toxicity infection after arthroplasty in our hospital from February 2010 to February 2016.Among them，there were 4 male patients and 8 female patients.They aged from 65 to 75 with an average of 70.There were four patients with an infection after a total hip replacement and eight patients with an infection after a total knee replacement.The infection appears from the seventh day to one month after the replacement.Three patients with fistula and three patients with an acute infection underwent prothesis retention debridement，and they were treated with antibiotics for a week according to the results of drug sensitivity results.Then they took 300 mg of rifampicin and 500 mg of ciprofloxacin twice a day for six months.The other six patients were treated with rifampicin andotherantibioticsaccording to the results of drug sensitivity results.If the results were not good，they would have a prothesis retention debridement again and then have a rifampicin combination therapy.All patients were followedup，and follow-up visit period ranged from 6 to 27 months with an average of 24 months.Follow-up observation included：blood cell counts，blood sedimentation，C-reactive protein，liver function and imaging data，joint motion degree and joint function.The cure standard included the foll：There was no clinical infection；blood sedimentation was less than 20 mm/h，C-reactive protein was less than 5 mg/L or it significantly reduced and returned to normal；joint pain decreased or disappeared；range of joint motion was good.Results One patient had prosthesis failure in the therapeutic process.After accepting the joint revision，the patient was cured.The other 11 patients finished 6 months treatment.9 of them were cured successfully，but 2 of them failed.The overall cure rate was 81.8%.The infection was controlled.Conclusion Prothesis retention debridement and rifampicin in the treatment of early low toxicity infection after arthroplasty have a certain clinical efficacy and safety，which provides a certain reference value for the treatment of early low toxicity infection after arthroplasty.

Key words： rifampicin ciprofloxacin infection debridgment

作者简介: 唐淼(1981－ )，男，主治医师，安徽医科大学宿州医院，宿州市立医院骨科，234000。

引用本文:

唐淼，汤瑞新，周烨，赵鹏，年争好. 利福平联合用药结合保留假体清创术治疗人工关节初期感染[J]. 实用骨科杂志, 2017, 23(7): 593-596.
Tang Miao，Tang Ruixin，Zhou Ye，et al. Clinical Experience of Prothesis Retention Debridement and Rifampicin in Early Low Toxicity Infection after Arthroplasty. sygkzz, 2017, 23(7): 593-596.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2017/V23/I7/593

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