含抗生素关节型骨水泥间隔体治疗老年肩关节感染的疗效分析  

Antibiotic articular cement spacer for shoulder infection in the elderly

作　　者：张瑜博 程鹏飞[1] 徐铮宇[1] 陈小华[1] 张毅[1] 沈灏[1] 韩培[1] Zhang Yubo;Cheng Pengfei;Xu Zhengyu;Chen Xiaohua;Zhang Yi;Shen Hao;Han Pei(Department of Orthopaedics,The Sixth People's Hospital,Affiliated to Shanghai Jiao Tong University,Shanghai 200233,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中华创伤骨科杂志》2021年第5期409-413,共5页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨在一阶段手术中,含抗生素关节型骨水泥间隔体对老年肩关节骨关节感染的治疗效果。方法回顾性分析2018年5月至2019年12月上海交通大学附属第六人民医院骨科治疗的3例肩关节感染患者资料。男1例,女2例;年龄平均65.3岁;其中1例为肩关节穿刺后感染,1例为肱骨近端骨折术后感染,1例为肩关节假体置换术后感染。3例患者均一期彻底清创,行含抗生素的肩关节型骨水泥间隔体植入,均未进行二期手术。末次随访时采用美国肩肘外科协会评分(ASES)、上肢功能障碍评分(Quick-DASH)、疼痛视觉模拟评分(VAS)以及肩关节活动范围以评定疗效。结果3例患者术后获18~28个月(平均22.7个月)随访,均未出现感染复发,间隔体位置良好。患者培养检出微生物分别为1例短双歧杆菌和2例耐甲氧西林的金黄色葡萄球菌。末次随访时ASES评分平均为54.4分(46.3~60.0分),Quick-DASH评分平均为45.1分(40.8~50.0分),VAS评分平均为2.3分(2~3分);肩关节活动范围:抬高角度平均为65.7°,外展角度平均为43.8°,外旋角度平均为21.7°。结论对于老年肩关节感染患者,彻底清创后留置关节型骨水泥间隔体可良好控制感染,同时在功能和疼痛方面有较大改善,避免了二期手术。Objective To investigate the therapeutic effects of antibiotic articular cement spacer on shoulder joint infection in the elderly patients during stage-one operation.Methods The data of 3 patients were analyzed retrospectively who had been treated at Department of Orthopaedics,The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University for shoulder infection from May 2018 to December 2019.They were one man and 2 women with an average age of 65.3 years(from 64 to 67 years).One case of infection followed shoulder puncture,another proximal humeral fracture and another shoulder prosthesis replacement.All the 3 patients underwent radical debridement and implantation of antibiotic shoulder cement spacer in stage-one operation but no stage-two operation.The therapeutic effects were evaluated by American Shoulder and Elbow Surgeons(ASES)scoring,Quick Disabilities of the Arm,Shoulder,and Hand(Quick-DASH)scoring,Visual Analog Scale(VAS),and range of shoulder motion.Results The 3 patients were followed up for 18 to 28 months(mean,22.7 months).There was no recurrence of infection and the spacers were in good position.The microorganisms detected were Bifidobacterium brevis in one case and methicillin-resistant Staphylococcus aureus in 2 cases.At the final follow-up,the ASES scores averaged 54.4(from 46.3 to 60.0),Quick-DASH scores 45.1(from 40.8 to 50.0),VAS scores 2.3(from 2 to 3),ranges of elevation 65.7°,ranges of abduction 43.8°and ranges of external rotation 21.7°.Conclusion For the elderly patients with shoulder infection,implantation of antibiotic shoulder cement spacer after radical debridement can well control infection,relieve pain and improve shoulder functions,sparing them secondary operation.

关 键 词：老年人 肩关节 感染控制 含抗生素骨水泥 关节型间隔体 

分 类 号：R687.3[医药卫生—骨科学]