摘要
目的建立全膝关节置换术后感染模型并探讨其可行性及应用价值。方法选取健康新西兰大白兔46只,随机分成3组:对照组10只,模型组18只,术后未感染组18只;模型组和术后未感染组均使用人指间关节假体行右侧膝关节置换,术后3天,模型组关节腔内注射甲氧西林敏感金黄色葡萄球菌(MSSA)105cfu,术后未感染组注射生理盐水;对照组在相同的条件下打开、关闭右膝关节关节囊。分别于术前和术后1周、3周观察各组X线检查、3.0T MRI图像、18F-FDG显像变化、白细胞计数、C反应蛋白(CRP)、血沉指标,术后3周观察病理学、微生物学变化。结果模型组大白兔术后3周后成活率88.8%(16/18);影像学检查显示模型组术后关节肿胀,关节腔及假体周围组织可见大量积液;18F-FDG显像显示模型组患侧膝关节局部放射性浓聚,术后3周患侧与对侧正常膝关节放射性比值(ONKR)较术后未感染组有统计学差异(Q=4.86,P<0.05);模型组术后1周白细胞计数较对照组有统计学差异(Q=5.45,P<0.05);模型组术后1周ESR检测较对照组有统计学差异(Q=5.82,P<0.05);模型组术后3周白细胞计数较对照组有统计学差异(Q=9.26,P<0.05);模型组术后3周ESR检测较对照组有统计学差异(Q=9.76,P<0.05);术后3周白细胞计数较术后未感染组有统计学差异(Q=4.46,P<0.05);病理学检测可见模型组假体周围及周围组织大量炎细胞侵润;微生物学检测显示模型组关节液培养均为阳性,术后未感染组阳性2例。结论该方法可建立稳定性高、重复性好的全膝关节置换术后感染模型。
Objective To establish an animal model of the infection after total knee arthroplasty （TKA） and to evaluate the value of its application. Methods 46 New Zealand male rabbits weighing 3.0~3.5 kg were randomly divided into three groups： the control group （n=10）, the model group （n=18）, the non infection TKA group（n=18）. The Swanson flexible hinge toe implants were used as knee prothesises. At the 3rd day postoperatively, 105 cfu of a clinical strain of methicillin susceptible staphylococcus aureus （MSSA） was injected into the operated knees of the model group, while the non infection TKA group were injected with the sterile saline. X ray, 3.0T MRI, 18F FDG PET, WBC, C Reactive protein, erythrocyte sedimentation rate （ESR）, pathological examination and microbiologic examinations were determined in the 1st and the 3rd weeks after the surgery. Results 88.8% （16/18） survival rate was achieved 3 days after the operation; the MRI showed evidence of prosthetic infection; there was periprosthetic radio activity presenting on 18F FDG of the operated knees in the model group. There was a statistically significant difference in the operated to normal knee activity ratios （ONKR） between the model group and the non infection TKA group 3 days after the operation （Q=4.86, P〈0.05）. The difference of WBC was statistically significant between the model group and the control group in the 1st week after the operation （Q=5.45, P〈0.05）. The difference of ESR was statistically significant between the model group and the control group in the 1st week after the operation （Q=5.82, P〈0.05）. The difference of WBC was statistically significant between the model group and the control group in the 3rd week after the operation （Q=9.26, P〈0.05）. The difference of ESR was statistically significant between the model group and the control group in the 3rd week after the operation （Q=9.76, P〈0.05）. There was statistical difference for the level of WBC between the model group and the non infection TKA group 3 days after the operation （Q=4.46, P〈0.05）. Histologic examination showed abscess formation and scattered poly morphonuclear leukocytes infiltration inside the joints of the model group. The cultures for bacteria of all samples from the model group and two samples from the non infection TKA group were positive. Conclusion This method can provide prosthetic infection model which is effective, reproducible and similar to the situation of prosthetic infection in human.
出处
《中华关节外科杂志（电子版）》
CAS
2014年第1期60-64,共5页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
国家自然科学基金项目(31070861
81171745)
关键词
关节成形术
感染
模型
动物
磁共振成像
Arthroplasty
Infection
Model,animal
Magnetic resonance imaging
