非骨水泥假体二期翻修治疗慢性人工全髋关节置换术后感染  

Cementless two-staged total hip arthroplasty for chronic periprosthetic infection

作　　者：沈灏[1] 王俏杰[1] 张先龙[1] 蒋垚[1] 王琦[1] 陈云苏[1] 邵俊杰[1] 

机构地区：[1]上海交通大学医学院附属第六人民医院关节外科,200233

出　　处：《中华外科杂志》2012年第5期402-406,共5页Chinese Journal of Surgery

摘　　要：目的探讨非骨水泥假体二期翻修治疗慢性髋关节假体周围感染的临床疗效。方法回顾性分析自2002年1月至2009年12月因髋关节假体周围慢性深部感染而采用非骨水泥股骨组件行二期翻修的23例患者资料，其中男性9例，女性14例；年龄52-78岁，平均（64±8）岁。所有患者一期手术彻底清创并插入含抗生素骨水泥间隔物，术后静脉使用敏感抗生素2周后改口服抗生素4周。一期取出假体术后平均6．7个月（3-28个月）采用非骨水泥股骨假体进行二期翻修术，术后静脉使用抗生素2周后改口服抗生素4周，然后停药。观察统计手术相关并发症，评估关节功能及治疗效果。结果术后平均随访（4．3±3．5）年，所有病例中2例再次发生感染，有3例发生术中骨折，1例在两次手术中间发生间隔物脱位，二期翻修手术后共2例发生脱位。所有病例中1例患者出现股骨柄轻度下沉，所有感染未复发病例均没有发生股骨组件和非骨水泥髋臼组件的松动。Harris评分从术前（36±13）分上升到术后12个月（85±13）分。结论采用非骨水泥假体二期翻修治疗髋关节假体周围慢性感染可以获得良好的感染控制率和假体稳定性，但对耐药菌感染的治疗采用非骨水泥假体时需要慎重。Objective To determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthmplasty. Methods Twenty- three patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study. There were 9 male patients and 14 female patients with an average age of 64 years （range, 52-78 years）. In all cases, antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been doue. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal. After a mean interval of 6. 7 months （ 3-28 months） , revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics. Results The mean follow-up period was （4. 3 ± 3.5 ） years. There were 2 cases of recurrent infections in this study. Intraoperative periprosthetic fractures were observed in 3 patients. One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation. Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and eementless acetabular components in patients without infection recurrence. The Harris hip score increased from a preoperative mean of 36 ± 13 to 85 ± 13 at 12 months after reimplantation. Conclusions Using cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability, but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.

关 键 词：关节成形术 置换 髋 髋假体 假体相关感染 再手术 

分 类 号：R687.4[医药卫生—骨科学]