人工关节置换术后感染的治疗体会  

Selection of Operative Opportunity for Infection after Joint Replacement

作　　者：吴杰[1] 王迪凡[1] 王志义[1] 

机构地区：[1]首都医科大学附属北京友谊医院骨科,北京100050

出　　处：《实用骨科杂志》2009年第11期815-816,873,共3页Journal of Practical Orthopaedics

摘　　要：目的探讨人工关节置换术后感染的原因、再手术的时机和方法的选择。方法自1992年1月至2008年6月我院共收治10例人工关节置换术后感染患者,7例髋关节置换,3例膝关节置换;其中男性5例,女性5例;年龄43～74岁,平均64.25岁。术后感染发生在3个月内者4例,1年内者3例,2年以上者3例。3例行清创、置管持续冲洗,静点或口服抗生素,其中1例行假体取出,关节旷置。1例因术中冰冻切片白细胞计数少于5个/高倍视野而行一期关节翻修。6例二期关节翻修。结果随访0.5～18年,平均随访9.25年。8例患者无感染复发迹象,感染治愈率80%。这其中6例疼痛消失,能独立行走,关节功能满意;1例术后形成无痛性假关节,可行走;1例因患者拒绝行翻修术,故行抗生素骨水泥临时假体取出截肢术。2例患者感染反复发作,口服及静点抗生素暂时控制感染。结论预防感染重于治疗。一旦关节置换术后感染发生,应尽早将假体取出。术中病理切片检查对诊断感染和决定手术方式有指导意义。二期行翻修术感染治愈率更高,假体置入更安全。Objective To analyse the causes of postoperative infection after joint replacement and the selection of operative opportunity and method.Methods 10 cases of postoperative infection that underwent prosthesis replacement were treated from Jan.1992 to Feb.2008.Of these,7 cases were hip infections,3 was a knee infection.The average age at operation was 64.25 years-old.The postoperative infection occurred within 3 months in 4 cases,1 year in 3 case,and later than 2 years in 3 cases.Two cases underwent debridement and drainage; 1 case underwent prosthesis removal ; 1 case underwent one-stage revision,and 3 cases underwent two-stage revision. Results All cases were followed up with an average follow-up time of 9.25 years. Good results were achieved in 8 cases. Poor resuhs were seen in 2 cases where recurrent sinus sepsis occurred. Conclusion The prevention of infection is more important than treatment. When the infection occurrence,as soon as possible remove the prosthesis. The degree of pathology in the operation is indicative for the diagnosis and the choice of treatment. Two stage revision is better and safer.

关 键 词：关节置换 并发症 感染 一期翻修 二期翻修 

分 类 号：R687.12[医药卫生—骨科学]