人工關節感染及預防

Prosthetic Joint Infection and Prevention

隨著人類平均餘命延長，代謝及老化的疾病日益增加。退化性關節炎是老年人常見的退化性疾病。拜醫學科技進步，我們可以用人工置換來解決嚴重的退化性關節炎。人工關節置換（常見的依序為膝關節、髖關節置換）在台灣甚至全世界都是一種常見的手術，台灣每年施行的人工關節置換在過去的十多年呈現數倍成長，現今每年執行的案例數超過25,000例，過去的研究顯示約1%-2%會出現後續的人工關節感染。本文將依序介紹人工關節感染的流行病學、危險因子、病理機轉、診斷標準及預防措施，特別介紹氨甲環酸（tranexamic acid, TXA），多數人熟悉的止血用藥，但在人工關節感染的預防上卻又陌生的藥物。TXA在人工關節置換手術，已經是一個建議用藥，希望將這個訊息傳達給相關的醫護同仁。

With the increasing average life expectancy of humans, metabolic and aging diseases are on the rise. Degenerative arthritis is a common degenerative disease among the elderly. Fortunately, advances in medical technology, have allowed us to address severe degenerative arthritis through the use of artificial replacements. Prosthetic arthroplasty, commonly involving knee and hip joint replacement, is a widespread surgical procedure in Taiwan and globally. The number of prosthetic joint replacements performed annually has increased several-fold over the past ten years. Currently, the annual replacement cases exceed 25,000 in Taiwan, and past studies have shown that about 1%–2% of these cases will develop subsequent prosthetic joint infections (PJI). This article provides an overview of the epidemiology, risk factors, pathological mechanism, diagnostic criteria, and preventive measures associated with PJI. We especially emphasize tranexamic acid (TXA), a hemostatic drug that is familiar to many, yet less recognized for its role in preventing infections associated with prosthetic joint replacement procedure. TXA is already a recommended drug for artificial joint replacement surgery, and we seek to convey this important message to our medical colleagues.