背景:假体周围感染(PJI)伴有伸肌机制破坏(EMD)和软组织缺损(以下称为“可怕的三联症”)是全膝关节置换术(TKA)后的一种破坏性并发症。这项研究的目的是确定对一组患有可怕三联症的患者进行治疗后的手术和临床结果。
方法:从2000年到2022年,127例患者仅接受PJI手术治疗,25对于具有软组织缺损的PJI(定义为需要皮瓣重建或作为决定进行膝上截肢(AKA)或关节固定术的因素的缺损),14对于带有EMD的PJI,和可怕的三合会22。感染状态的复合结果,运动范围,伸肌滞后,最后随访时的动态状态用于比较每组中具有良好整体膝关节结局的患者比例.使用单向方差分析与事后Tukey检验和Pearson卡方检验或Fisher精确检验与事后Bonferroni调整来确定组间差异。如适用。计算赔率比(OR),以比较组间的整体膝关节结果。对患者死亡率进行Kaplan-Meier生存分析。
结果:平均随访时间为8.4年,组间相似(P=0.064)。患有可怕三合会的患者有45.5%的AKA发病率,或者关节固定术,不良结局的发生率为86.4%。与PJI组的患者相比,PJI中存在软组织缺损的患者(OR=5.8,95CI[置信区间]2.2至15.7),带有EMD的PJI(OR=3.7,95CI1.0至12.9),和可怕的三联组组(OR=11.6,95CI3.3至41.5)显示出更高的不良膝关节结局的几率。
结论:这项研究表明,TKA可怕的三联症是一种可怕的诊断,结果较差。临床医生和患者可能会考虑早期截肢或关节固定术治疗。
BACKGROUND: Periprosthetic infection (PJI) with concomitant extensor mechanism disruption (EMD) and soft-tissue defect-hereinafter termed the \"Terrible Triad\"-is a devastating complication following total knee arthroplasty. The purpose of this study was to define the surgical and clinical outcomes following management of a cohort of patients who have the Terrible Triad.
METHODS: From 2000 to 2022, 127 patients underwent operative management for PJI alone, 25 for PJI with soft-tissue defects (defined as defects requiring flap reconstruction or being a factor contributing to the decision of performing above-knee amputation or arthrodesis), 14 for PJI with EMD, and 22 for the Terrible Triad. A composite outcome of infection status, range of motion, extensor lag, and ambulatory status at final follow-up was used to compare the proportion of patients in each group with a favorable overall knee outcome. Differences between groups were determined using one-way analyses of variance with post hoc Tukey\'s tests and Pearson\'s Chi-square tests or Fisher\'s exact tests with post hoc Bonferroni adjustments, where applicable. Odds ratios (OR) were calculated for comparison of the overall knee outcome between groups. A Kaplan-Meier survival analysis for patient mortality was performed.
RESULTS: The mean follow-up was 8.4 years and similar between groups (P = .064). Patients who had the Terrible Triad had a 45.5% incidence of above-knee amputation, or arthrodesis, and an 86.4% incidence of an unfavorable outcome. Compared to patients in the PJI group, patients in the PJI who had a soft-tissue defect (OR = 5.8, 95% CI [confidence interval] 2.2 to 15.7), PJI with EMD (OR = 3.7, 95%CI 1.0 to 12.9), and Terrible Triad groups (OR = 11.6, 95% CI 3.3 to 41.5) showed higher odds of an unfavorable knee outcome.
CONCLUSIONS: This study demonstrates that the total knee arthroplasty Terrible Triad is a dreaded diagnosis with poor outcomes. Clinicians and patients might consider early treatment with amputation or arthrodesis.
METHODS: III.