3例布氏杆菌引起的关节置换术后假体周围感染的诊断与治疗并文献复习

doi:10.6040/j.issn.1671-7554.0.2024.1076

摘要/Abstract

摘要： 目的探讨3例布氏杆菌引起的关节置换术后假体周围感染患者的早期诊断与治疗方式,并对相关文献进行复习。方法收集3例布氏杆菌导致的假体周围感染的临床资料,并复习相关文献对该疾病的诊治思路进行归纳总结。结果 3例患者经关节液或组织培养均被确诊为布氏杆菌引起的关节置换术后假体周围感染,并经布氏杆菌血清检测为阳性,其中1例患者合并大芬戈尔德菌感染;3例患者经过单纯抗感染、保留假体清创抗感染、二期翻修的治疗方式获得治愈。结论布氏杆菌引起的关节置换术后假体周围感染可以通过关节液或组织培养明确诊断,布氏杆菌血清学检测可以快速确诊,对假体无松动患者可以采用单纯抗感染或联合保留假体清创治疗;术前无法明确致病菌的假体周围感染患者可以采用二期翻修术治疗。

关键词: 关节置换术, 假体周围感染, 布氏杆菌, 全膝关节置换术, 全髋关节置换术

Abstract: Objective To review the early treatment and diagnositic modalities of 3 patients with Brucella periprosthetic joint infection and to review the relevant literature. Method The clinical data of the three patients with brucella periprosthetic joint infection were analysed, and the relevant literature was reviewed. Results The diagnosis of these three patients was confirmed by joint fluid or tissue culture. The serological tests of these patients were also positive. One patient was diagnosed with mixed infection and the pathogenic bacteria of the infection was Finegoldia magna. Symptoms were resolved after antibiotics alone, debridement antibiotics and implant retention(DAIR)or two-stage revision arthroplasty. Conclusion Cultures of synovial fluid and intraoperative periprosthetic tissue represent the routine method for diagnosing periprosthetic joint infection caused by brucella. Brucella serology test is helpful in the diagnosis. Antibiotics alone or debridement antibiotics and implant retention(DAIR)has been effective and should be considered first in patients without loosening of brucella-induced periprosthetic joint infection. Two-stage revision arthroplasty should be considered for patients in whom the pathogenic bacteria cannot be identified piror to surgery.

Key words: Arthroplasty, Periprosthetic joint infection, Brucella, Total knee arthroplasty, Total hip arthroplasty

中图分类号:

R687.4

马良,阎帅辰,李德强,姜淑伟,杨华璞,张元凯. 3例布氏杆菌引起的关节置换术后假体周围感染的诊断与治疗并文献复习[J]. 山东大学学报 (医学版), 2024, 62(12): 90-95.

MA Liang, YAN Shuaichen, LI Deqiang, JIANG Shuwei, YANG Huapu, ZHANG Yuankai. Brucella periprosthetic joint infection following total joint arthroplasty: three cases report and literature review[J]. Journal of Shandong University (Health Sciences), 2024, 62(12): 90-95.

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