背景:Hofmann等人。,1995年,首先描述了一种通过清洁和高压灭菌原始股骨部件制成的铰接垫片,然后重新植入新的胫骨聚乙烯。本系统评价旨在评估术中高压灭菌和再次使用感染假体的现有证据的状态。作为垫片,在假体周围关节感染(PJI)后的两阶段翻修期间。
方法:采用系统评价和荟萃分析的首选报告项目中描述的方法进行系统评价。OVID-MEDLINE®,EMBASE,科克伦图书馆,Scopus,WebofScience,从1995年到2020年4月,对GoogleScholar和PubMed进行了搜索,以确定相关研究。
结果:本系统综述包括14项研究:2项前瞻性病例系列;6项回顾性比较研究和6项回顾性病例系列。审查的研究包括567名患者(571个膝盖):394名患者接受高压灭菌组件治疗,173名患者使用新组件制成的垫片。重复使用高压灭菌成分的患者的累积再感染率为13.7%(394例患者中有54例再次感染),而对照组患者的再感染率为13.3%(173例患者中有23例再感染).使用高压灭菌组件作为垫片治疗的患者的最终运动范围,与接受静态垫片的患者相比,在四项比较研究中,有三项明显更高。
结论:有中等水平的证据表明,术中高压灭菌和再次使用受感染的假体作为垫片,在膝关节置换术中,是膝关节PJI管理的有效程序。
BACKGROUND: Hofmann et al., in 1995, first described an articulating spacer made by cleaning and
autoclaving the original femoral component, which is then re-implanted with a new tibial polyethylene. This systematic
review aims to assess the state of existing evidence on the intraoperative
autoclaving and re-use of an infected prosthesis, as a spacer, during a two-stage revision following Periprosthetic Joint Infections (PJI).
METHODS: A systematic
review was conducted with methods described in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. OVID-MEDLINE®, EMBASE, Cochrane Library, SCOPUS, Web of Science, Google Scholar and PubMed were searched from 1995 to April 2020 to identify relevant studies.
RESULTS: Fourteen studies were included in this systematic
review: two prospective case series; six retrospective comparative studies and six retrospective case series. The reviewed studies included 567 patients (571 knees): 394 patients treated with autoclaved components and 173 with a spacer made of new components. The cumulative re-infection rate in patients treated with re-used autoclaved components was 13.7% (54 re-infections in 394 patients), whereas in control patients the re-infection rate was 13.3% (23 re-infections in 173 patients). The final Range of Movement in patients treated using the autoclaved components as a spacer, compared with patients receiving static spacers, was significantly higher in three out of four comparative studies.
CONCLUSIONS: There is a moderate level of evidence that the intraoperative
autoclaving and re-use of an infected prosthesis as a spacer, during a knee resection arthroplasty, is an effective procedure in the management of knee PJI.