臨床整形外科51巻4号

2016年04月発行

誌上シンポジウム THA後感染の予防・診断・治療の最前線

感染人工股関節の治療成績

著者： 羽山哲生¹ 大谷卓也¹ 藤井英紀¹ 川口泰彦¹ 丸毛啓史¹

所属機関： ¹東京慈恵会医科大学整形外科学講座

ページ範囲：P.337 - P.342

　感染人工股関節の予防，診断と治療には非常に多くの因子が関与し複雑で困難な問題である．治療に際しては症例ごとに治療法を検討することが重要であり，基本的には二期的治療として徹底的な感染制圧をめざすこと，インプラント抜去は選択的に行うこと，articulating cement spacerを活用すること，また，術後の抗菌薬治療を強力に行うことなどにより，感染制圧と機能維持の両立を目指せるものと考える．

参考文献

1）Craig WA. Pharmacokinetic/pharmacodynamic parameters:rationale for antibacterial dosing of mice and men. Clin Infect Dis 1998;26(1):1-10.

2）Scaglione F. Can PK/PD be used in everyday clinical practice. Int Antimicrob Agents 2002;19:349-53.

3）Moran E, Byren I,Atkins BL. The diagnosis and management of prosthetic joint infections. J Antimicrob Agents Chemother 2010;65 (Suppl 3):45-54.

4）Esposito S, Leone S. Prosthetic joint infections:microbiology, diagnosis, management and prevention. Int J Antimicrob Agents 2008;32:287-93.

5）Senneville E, Joulie D, Legout L, et al. Outcome and predictors of treatment failure in total hip/knee prosthetic joint infections due to Staphylococcus aureus. Clin Infect Dis 2011;53:334-40.

6）Waldvogel FA, Madoff G, Swartz MN. Osteomyelitis:a review of clinical features, therapeutic considerations and unusual aspects. N Engl J Med 1970;282:198-206, 260-266, 316-22.

7）Nagoya S, Kaya M, Sasaki M, et al. Diagnosis of peri-prosthetic infection at the hip using triple-phase bone scintigraphy. J Bone Joint Surg Br 2008;90:140-4.

8）Parvizi J, Della Valle CJ. AAOS Clinical Practice Guideline:diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg 2010;18:771-2.

9）Williams JL, Norman P, Stockley I. The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. J Arthroplasty 2004;19:582-6.

10）Della Valle CJ,Sporer SM,Jacob JJ, et al. Preoperative testing for sepsis before revision total knee arthroplasty. J Arthroplasty 2007;22(6 Suppl 2):90-3.

11）Ghanem E,Parvizi J,Burnett RS, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am 2008;90:1637-43.

12）Trampuz A,Hanssen AD, Osmon Dr, et al. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med 2004;117:556-62.

13）Schinsky MF, Della Valle CJ, Sporer SM, et al. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am 2008;90:1869-75.

14）Banit DM, Kaufer H, Hartford JM. Intraoperative frozen section analysis in revision total joint arthroplasty. Clin Orthop Relat Res 2002;401:230-8.

15）Lonner JH, Desai P, Dicesare PE, et al. The reliability of analysis of intraoperative frozen sections for identifying active infection during revision hip or knee arthroplasty. J Bone Joint Surg Am 1996;78:1553-8.

16）Anagnostakos K, Jung J, Kelm J, et al. Two-stage treatment protocol for isolated septic acetabular cup loosening. Hip Int 2010;20:320-6.

17）Lee YK. Retaining well-fixed cementless stem in the treatment of infected hip arthroplasty. Acta Orthop 2013;84:260-4.

18）Ekpo TE, Berend KR,Morris MJ, et al:Partial two-stage exchange for infected total hip arthroplasty. Clin Orthop Relat Res 2014;472:437-48.