全人工膝關節置換術後之黴菌感染：一例報告

Candida Infection after Total Kness Arthroplasty: a Case Report

我們所報告病例是一在個在全人工膝關節置換術後發生念珠菌屬黴菌感染，我們採用兩階段治療，第一階段，先移除感染的人工膝關節，並給予徹底的清創術及置入Septopal鏈珠，並在麻醉下由長腿石膏固定(long leg cast)來維持下肢的長度，之後在關節液培養確定是黴菌感染後，給予抗黴菌藥物(fluconazole)及預防性的抗生素治療。第二階段等候至C型反應性球蛋白降至正常（小於 0.5 mg/dL）後，再置入新的人工膝關節(revision total knee arthroplasty)，術後繼續使用fluconazole治療長達68天。病人於停藥後傷口癒合良好，至今不再出現感染症狀及徵象，沒有傷口紅腫痛的現象，膝關節也可以彎曲至少90度，步行良好。因此將我們所遇到的病例提出來，以期待大家對人工膝關節黴菌感染的途徑、診斷、治療及預防有更深一層的認識。

Fungal infection after prosthetic arthroplasty is rare. We report on a 73-year-old woman who developed Candida parapsilosis infection after total knee arthroplasty. Diagnosis was made on the basis of repeated cultures of aspirated synovial fluid. The patient was treated with a 2-stage revision arthroplasty. In the first stage, infected prosthesis was removed and the affected tissue was carefully debrided. An appropriate intravenous anti-fungal agent (fluconazole) and antibiotics were given. In the second stage, revision total knee arthroplasty was done after the infection had been controlled (C-reactive protein < 0.5 mg/dL), and fluconazole was given for another 68 days after the operation. The patient has remained well during about two months of follow-up, even after cessation of medication.