优化的不扰动髓腔关节型间隔物治疗感染性髋关节炎  

Treatment of infectious hip arthritis with optimized articulating medullary-sparing spacer

作　　者：郭阁永 王俏杰[1] 沈灏[1] Guo Geyong;Wang Qiaojie;Shen Hao(Department of Orthopaedics, Shanghai Jiaotong University Affiliated Sixth People＇ s Hospital, Shanghai 200233, Chin)

机构地区：[1]上海交通大学附属上海市第六人民医院骨科,200233

出　　处：《中华骨科杂志》2018年第9期549-555,共7页Chinese Journal of Orthopaedics

摘　　要：目的 探讨优化的不扰动髓腔关节型间隔物治疗感染性髋关节炎的临床疗效.方法 回顾性分析2010年6月至2016年6月采用不扰动髓腔关节型间隔物治疗15例感染性髋关节炎患者资料,其中男6例,女9例;首次入院年龄32～61岁,平均（49.6±9.6）岁;8例为原发性髋关节感染,7例为继发性髋关节感染.一期手术彻底清创后,以直径较大的相互成角的斯氏针为内骨骼,联合阴模压制的股骨头间隔物,制作并安装优化的不扰动髓腔间隔物,感染控制后行二期全髋关节置换手术治疗感染性髋关节炎.检测术前、间隔期及末次随访时髋关节感染情况,观察间隔期间隔物及二期手术后植入假体的稳定性,比较各期髋关节功能Harris评分.结果 15例患者髋关节感染均治愈,随访时间28～62个月,平均（40.9±10.8）个月.1例患者间隔期内发生间隔物脱位,成功手法复位,其余14例患者间隔期内患肢维持良好的功能及部分承重能力.二期全髋关节置换术后未见假体松动、脱位、骨折、深静脉血栓形成、主要血管和神经损伤等并发症.患者的临床症状及髋关节功能得到明显改善,Harris髋关节评分从术前的（33.7±6.9）分提高到间隔期的（59.5±8.5）分和末次随访的（90.8±4.4）分,三个时期的Harris评分之间相互比较差异均有统计学意义.结论 以直径较大的相互成角的斯氏针为内骨骼,联合阴模压制的股骨头间隔物,有效增强了不扰动髓腔间隔物的机械强度.此优化的不扰动髓腔间隔物在有效治疗感染性髋关节炎的同时,使患肢在间隔期内获得良好的功能和部分负重能力. Objective To explore the clinical effects of optimized articulating medullary-sparing spacer in the treatment of infectious hip arthritis.Methods From June 2010 to June 2016,the clinical data of 15 patients with infectious hip arthritis who were treated by modified articulating medullary-sparing spacer were analyzed retrospectively.There were 6 males and 9 females with the average age of 49.6±9.6 years old （range,32-61 years）.8 cases were primary hip infections and 7 cases were secondary hip joint infections.After complete debridement in the first phase of surgery,the modified articulating medullary-sparing spacers were fabricated and installed using the larger diameter and angled Steinmann pins as the endoskeleton and the femoral head spacers made by hubbing.Two-stage THA revision for each patient was conducted after infection controlled.To evaluate the clinical results,the infection and treatment condition of every patient were collected at preoperative,interim period and latest fellow-up.The spacer status in interim period and prosthesis status after two-stage THA revision were observed.And Harris hip score system was used to evaluate the hip joint function in different stages.Results All patients were cured with mean follow-up time of 40.9± 10.8 months （range,28-62 months）.During the interim period,spacer dislocation was observed in a case,which was successfully treated by manual reduction under general anesthesia.In other cases,the affected limbs maintained good function and partial weight bearing.After the second-stage THA,no prosthesis loose,dislocation,fracture,deep vein thrombosis and injury of major vessels or nerves were observed.The clinical symptoms and hip joint function of all cases were significantly improved.The Harris hip score was improved from 33.7±6.9 preoperatively to 59.5±8.5 in interim period and 90.8±4.4 at the latest fellow-up,and the difference was statistically significant among three stages.Conclusion The larger diameter and angled Steinmann pins as the endoskeleton

关 键 词：髋关节炎 感染 关节成形术 置换 髋 

分 类 号：R687.4[医药卫生—骨科学]