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International Journal of Clinical Research. 2021; 5: (1) ; 10.12208/j.ijcr.20210001.

Recent advances in the treatment of fungal periprosthetic infections after knee arthroplasty
膝关节置换术后真菌性假体周围感染治疗的最新进展

作者: 孟鑫,蔡有军,王飞,徐源*

陆军军医大学第二附属医院

*通讯作者:徐源,单位:陆军军医大学第二附属医院;

引用本文: 孟鑫,蔡有军,王飞,徐源. 膝关节置换术后真菌性假体周围感染治疗的最新进展[J]. 国际临床研究杂志, 2021, 5(1) : 1-7.
Published: 2021-01-29

摘要

当下骨性关节炎越来越普遍,目前作为治疗终末期膝关节骨性关节炎的最有效方式为人工膝关节置换术,现已越发普及。但关节假体周围感染(prosthetic joint infection,PJI)仍然是关节置换手术的毁灭性的并发症。伴随着我们国家手术技术的改善,PJI的发病率正在逐步下降,在我们首次膝关节置换术中发病率为2.5%,但是因为在膝关节置换术总量逐步增加情况下,PJI的发病数量也在逐步增加。虽然真菌感染在PJI中占比较小,约仅仅占关节置换术后感染总量的1%[1]。可是真的不幸被真菌感染了,由于诊断和治疗的不及时而可能引起真菌性PJI,进而引起严重的并发症。将会给患者带来不可想象的灾难。本文使用PubMed、Embase、Medline检索了1988年至2020年关于膝关节置换术后真菌性假体周围感染的大量文献进行综合分析。膝关节置换术后假体周围真菌感染患者的全身疾病患病率较高,手术治疗后的预后较差。仅仅行灌洗和清创术,难以控制感染,长期预后较差,可能无法作为真菌性假体周围感染的治疗首要选择。展望未来,我们的工作应集中在:1、运用PCR检测、获取术中感染组织标本或分泌物直接染色,显微镜下找病原菌及组织快速冷冻涂片来发现致病真菌、有条件的医院可行抗原和抗体检测和β-D-葡聚糖等快捷准确的诊断方式;2、优化一期及二期关节翻修术;3、关注这些患者的全身抗真菌药物治疗状况[2, 3]。本文将探讨膝关节置换术后真菌性假体周围感染治疗的最新进展。

关键词: 膝关节置换;真菌感染;治疗进展;骨水泥

Abstract

Nowadays, osteoarthritis is becoming increasingly common. As the most effective treatment for end-stage knee osteoarthritis, artificial knee arthroplasty has been gaining popularity. However, periprosthetic joint infection (PJI) is still a devastating complication of joint replacement surgery. With the improvement of surgical techniques in China, the incidence of PJI is decreasing, which is 2.5% in the Primary Total Knee Arthroplasty. However, it is increasing gradually as the total knee arthroplasty increases. Although fungal infection accounts for a relatively small proportion in PJI, only 1% of the total infection after joint replacement [1], if patients are unfortunately infected, fungal PJI may be caused due to the untimely diagnosis and treatment, which may lead to serious complications and bring unimaginable disaster to patients. This paper used PubMed, Embase and Medline to retrieve a large number of literature on fungal periprosthetic infections after knee arthroplasty from 1988 to 2020 for comprehensive analysis.Patients with periprosthetic fungal infection after knee arthroplasty had a higher prevalence of systemic diseases and a worse prognosis after surgical treatment. It is difficult to control infection by lavage and debridement alone, and the long-term prognosis is poor, so they may not be the first choice for the treatment of fungal periprosthetic infection. Looking forward to the future, we will focus our work on the following three parts: 1. using PCR to detect and obtain intraoperative infected tissue specimens or secretions for direct staining; looking for pathogenic bacteria and tissue rapid frozen smears under the microscope to find pathogenic fungi; carrying out rapid and accurate diagnostic methods such as antigen and antibody detection and β - D-glucan if conditions permit in hospital. 2. optimizing primary and secondary joint revision surgery; 3. paying attention to the status of systemic antifungal therapy in these patients [2, 3].This article will discuss the latest progress in the treatment of fungal periprosthetic infections after knee arthroplasty.

Key words: total knee arthroplasty (TKA);fungal infection;Progress in treatment;bone cement

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