抗生素骨水泥间置器二期翻修治疗人工髋关节感染  

Treatment of infection after hip arthroplasty using antibiotic-impregnated cement spacer by two-stage exchange arthroplasty

作　　者：戴勇[1] 尚希福[1] 胡飞[1] 段丽群[1] 纪小枫[1] 

机构地区：[1]安徽医科大学附属省立医院骨二科,安徽合肥230001

出　　处：《临床骨科杂志》2010年第6期619-622,共4页Journal of Clinical Orthopaedics

摘　　要：目的探讨应用抗生素骨水泥间置器二期翻修治疗人工髋关节感染的疗效。方法对14例初次髋关节置换术后感染的患者行二期翻修手术,所有患者一期手术取出假体并彻底清创,使用去甲万古霉素1 g与骨水泥20 g的抗生素骨水泥临时间置器,平均间隔（3.6±1.2）个月后二期置换。手术前后髋关节功能行Harris评分。结果一期处理后所有伤口均愈合,14例均获随访,时间7~29（16±5.9）个月。术后无感染复发,随访期间无脱位、深静脉血栓形成、异位骨化等并发症。末次随访时Harris评分72~91（81±6.8）分,较术前22~51（39±8.1）分平均提高（42±1.7）分。优2例,良10例,可2例,无差病例。结论彻底清创,采用抗生素骨水泥间置器为局部提供高浓度抗生素的二期翻修术是控制感染的有效措施。Objective To assess the effects of antibiotic-impregnated cement spacer on the management of infection after hip arthroplasty.Methods The replacemennt of the infected total hip arthroplasty in two stages was performed in 14 patients.In the first stage operation,the following steps were performed： complete debridement,removal of infected prothesis,addition of 1 g of Vancomycin to 20 g bone cement forming Vancomycin-impregnated cement spacer.After（3.6±1.2） months,antibiotic-loaded prosthesis was implanted in the second stage.The hip functions before and after operation were evaluated by Harris score.Results After the first procedure,between 7~29 months,all the wounds were closed smoothly and the mean follow-up after revision was（16±5.9） months.None of 14 patients had a recurrence of the infection.There were no cases of dislocation,deep-vein thrombosis,heterotopic ossification during the follow-up.The mean postoperative Harris Hip Score averaged 81±6.8（72~91） points and increased about 42±1.7 points than preoperative score averaged 39±8.1（22~51）.In this group,2 cases were excellent,10 cases were good,2 cases were fair.Conclusions The effective treatment of infection after hip arthroplasty are complete debridement,using antimicrobial agents-loaded cement spacer with two-stage revision.

关 键 词：外科伤口感染 二期翻修术 抗生素骨水泥 间置器 去甲万古霉素 

分 类 号：R687.4[医药卫生—骨科学] R978.1[医药卫生—外科学]