产气荚膜杆菌致髋关节置换术后血源性感染一例报告  

Hematogenous infection of total hip arthroplasty due to clostridium perfringens: a case report

作　　者：孙长鲛[1] 付立功[1] 杜瑞勇 刘璞 吴厦 张威[1] 蔡谞 Sun Changjiao;Fu Ligong;Du Ruiyong;Liu Pu;Wu Sha;Zhang Wei;Cai Xu(Department of Orthopaedics,Beijing Tsinghua Changgung Hospital,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院骨科,102218

出　　处：《中华骨科杂志》2019年第17期1083-1086,共4页Chinese Journal of Orthopaedics

摘　　要：报道1例产气荚膜杆菌导致髋关节置换术后血源性感染的病例。患者双髋关节置换术后13年,因双髋疼痛伴发热1周入院。通过病史、体格检查和影像学检查确诊为假体周围感染,经细菌培养为产气荚膜杆菌,发病原因考虑与患者的胆囊结石有关。因为早期血源性感染,故给予彻底清创、保留假体、灌注冲洗治疗,最终感染得到控制。通过文献复习发现产气荚膜杆菌导致假体周围感染的病例极为罕见,且均以个案的形式报道。根据文献报道及该病例的预后发现产气荚膜杆菌导致的假体周围感染仅局限在关节周围部位,虽不像气性坏疽严重、发展迅速,但也应引起高度重视。产气荚膜杆菌导致的血源性假体周围感染前期有胃肠道症状时,应高度警惕胆囊病变,同时采用保留假体的治疗方法可能会获得良好预后。A case report of periprosthetic hip clostridium perfringens infection 13 years after total hip arthroplasty, the patient had hip pain with fever for one week. Physical examination and imaging examination confirmed the periprosthetic joint infection. The pathogenic bacterium was clostridium perfringens according to bacterial culture, and the pathogenic bacterium of clostridium perfringens was suspected relating to the gallbladder disease in this patient. Considering such periprosthetic joint infection was early stage hematogenous periprosthetic joint infection, treatment of debridement, retention of the prosthesis, irrigating, and indwelling drainage tube were conducted. By reviewing literature about periprosthetic clostridium perfringens infection, only seven reports of periprosthetic joint infection were caused by clostridium perfringens, which were all case reports. From the previous case reports and our case, we found that the infection around the prosthesis caused by clostridium perfringens was limited to the area around the joint, and prognosis of such cases may not be as severe as the natural gas gangrene which developed very rapidly, but great attention should be paid to. The hematogenous periprosthetic joint infection caused by clostridium perfringens who had gastrointestinal symptoms in the early stage should be highly suspicious of gallbladder lesions and thorough debridement, retention of the prosthesis, irrigating and indwelling drainage tube maybe a treatment method.

关 键 词：髋关节置换术后 产气荚膜杆菌 血源性感染 关节周围 文献复习 影像学检查 胃肠道症状 体格检查 

分 类 号：R687.4[医药卫生—骨科学]