二期翻修术治疗人工髋关节置换术后感染的中期疗效  

MID-TERM EFFECTIVENESS OF TWO-STAGE HIP PROSTHESIS REVISION IN TREATMENT OF INFECTION AFTER HIP ARTHROPLASTY

作　　者：汪龙[1] 胡懿郃[1] 戴子勋[1] 周佳林[1] 李明清[1] 李康华[1] 

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中国修复重建外科杂志》2011年第6期646-649,共4页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨二期翻修术治疗人工髋关节置换术后感染的中期疗效。方法 2002年4月-2006年11月,收治12例人工髋关节置换术后感染患者。男5例,女7例;年龄47～72岁,平均59.8岁。人工股骨头置换2例,人工全髋关节置换10例。置换术后1～67个月发生感染。感染根据Segawa分型标准:2型1例,3型2例,4型9例。Harris评分为(36.7±6.1)分。9例C反应蛋白增高,10例红细胞沉降率增高。细菌培养提示阳性8例,阴性4例。一期清创术取出假体、彻底清创,采用抗生素骨水泥自制占位器或感染治疗型临时假体占位,术后抗感染治疗;3～10个月后行二期翻修术。结果 1例一期清创术后感染未控制,再次清创并采用抗生素骨水泥自制占位器治疗后,感染控制。其余患者术后切口均Ⅰ期愈合,无下肢深静脉血栓形成和神经损伤等并发症发生。患者术后均获随访,随访时间3～8年,平均5.4年。随访期间患者无感染复发及关节脱位。末次随访时,2例髋关节活动时有隐痛,3例有轻度跛行;Harris评分为(81.6±4.5)分,与术前比较差异有统计学意义(t=52.696,P=0.000);X线片示假体无松动及明显下沉,植骨处愈合。结论 二期翻修术治疗人工髋关节置换术后感染控制率高,可获较好中期疗效。Objective To evaluate the mid-term effectiveness of two-stage hip prosthesis revision in the treatment of infection after hip arthroplasty.Methods Between April 2002 and November 2006,12 cases of infection after hip arthroplasty were treated.There were 5 males and 7 females,aged from 47 to 72 years（mean,59.8 years）.The femoral head arthroplasty was performed in 2 cases and total hip arthroplasty in 10 cases.Infection occurred 1 to 67 months after arthroplasty.According to the Segawa classification criteria,infections included type 2 in 1 case,type 3 in 2 cases,and type 4 in 9 cases.The preoperative Harris score was 36.7 ± 6.1.Nine cases had elevated C reactive protein and 10 cases had elevated erythrocyte sedimentation rate.The results of bacterial culture were positive in 8 cases and negative in 4 cases.After the removal of the infected prosthesis and thorough debridement,antibiotic-loaded cement spacers or infected therapeutic temporary prosthesis were used as placeholders,and then the anti-infection treatments were given after operations;two-stage hip prosthesis revisions were performed 3 to 10 months after debridement.Results In 1 patient who failed to control infection after debridement,infection was controlled after the second debridement and the antibiotic-loaded cement spacer as placeholder.Other patients achieved healing of incision by first intention,and no complication such as deep venous thrombosis and nerve injury occurred.All patients were followed up 3 to 8 years after revision（mean,5.4 years）.During the follow-up,no infection recurrence and joint dislocation occurred.Dull pain was present in 2 cases during activity and mild claudication in 3 cases at last follow-up.The Harris score was 81.6 ± 4.5,showing significant difference（t=52.696,P=0.000） when compared with preoperative score.The X-ray films showed that no prosthesis loosening and obvious subsidence were observed,and bone graft healed.Conclusion The two-stage hip prosthesis revision has good infection control rate and mid-term

关 键 词：人工髋关节置换术 感染 二期翻修术 中期疗效 

分 类 号：R687.4[医药卫生—骨科学]