슬관절 전치환술 후 감염의 치료
Treatment of Infected Total Knee Arthroplasty
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초록
슬관절 전치환술 후 발생하는 심부 감염은 가장 심각한 합병증으로 슬관절 전치환술 실패의 주요한 원인 중 하나이다. 슬관절 전치환술 후의 심부 감염률은 과거 1.3∼2.9%로 보고되었으나, 수술 환경의 개선, 수술 술기의 향상, 수술 전후 예방적 항생제 사용 및 항생제 혼합 골시멘트의 사용 등으로 최근에 0.5∼1%로 보고되고 있다. 슬관절 전치환물 후 감염의 치료 목적은 통증이 없고, 기능을 잘 유지하며 감염을 박멸하는 것인데, 그 치료가 어렵고 치료 결과 또한 항상 좋은 것은 아니어서 관절 유합술이나 절단 혹은 가관절의 형성 등의 결과를 야기할 수 있다. 치료로는 항생제 치료, 변연 절제술, 절제 관절성형술, 관절 유합술, 재치환술, 절단술 등이 있으며, 최근에는 치료와 관절의 운동성을 유지 할 수 있는 2단계 재치환술이 선호되고 있지만, 슬관절 전치환술 후 4주 이내에 발생한 감염이나, 누공이 없고 삽입물이 견고하게 고정되어 있는 급성 혈행성 심부 감염의 치료는 삽입물을 보존하며 개방적 변연절제술를 시행할 수 있다. 초기 심부 감염에 대해서는 가능한 조기에 적절할 항생제 투여와 함께 적극적인 변연절제술로 삽입물의 제거 없이 만족할 만한 결과를 얻을 수 있고, 만성 감염의 경우 삽입물 제거 후 이단계 재치환술이 만성 감염의 치료로 가장 중요하다.
Abstract
Deep infection after total knee arthroplasty (TKA) represents a significant treatment challenge with the possibility of disastrous consequences. The rate of deep infection rate after TKA was reported to be 1.3∼2.9% in the past. With the improvements of the operation environment and operative technique and the use of prophylactic antibiotics and antibiotic-mixed bone cement, the rate of deep infection was recently reported to be 0.5∼1%. The goal of treatment of a periprosthetic TKA infection is the restoration of a painless, well-functioning joint, with eradication of the infection. Yet the outcome is not always favorable, and the end result could be an arthrodesis, amputation or a pseudoarthrodesis. In some instance, the only realistic option is to suppress the infection with continued oral antibiotics while simultaneously retaining the prosthesis. Two-stage resection arthroplasty remains the standard treatment for chronic periprosthetic infection. Early deep infection may be treated with aggressive debridement and intravenous antibiotics without removal of the implant. Two-stage reimplantation after removal of the implant is most important for the treatment of chronic infection.
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