新型高光面抗生素骨水泥间隔器治疗髋关节假体周围感染的早期疗效分析  

Early efficacy of a new highly-polished antibiotic-loaded articulating cement spacer in treating periprosthetic hip joint infection

作　　者：钟达[1] 谷四全 雷鹏飞[1] 高发维 王成功[1] 苏士龙 涂皓城 齐军 Da Zhong;Si-quan Gu;Peng-fei Lei;Fa-wei Gao;Cheng-gong Wang;Shi-long Su;Hao-cheng Tu;Jun Qi(Department of Orthopedics,Xiangya Hospital Central South University,Changsha,Hunan 410008,China)

机构地区：[1]中南大学湘雅医院骨科,湖南长沙410008

出　　处：《中国现代医学杂志》2021年第20期6-12,共7页China Journal of Modern Medicine

基　　金：国家自然科学基金(No:81974360)。

摘　　要：目的探讨高光面抗生素骨水泥间隔器治疗髋关节假体周围感染(PJI)的早期临床疗效。方法选取2018年8月—2019年12月在中南大学湘雅医院诊断为髋关节置换术后假体周围感染的15例患者,在二期翻修前应用高光面抗生素骨水泥间隔器行旷置术,所有患者在旷置期间经抗感染治疗有效后行髋关节二期翻修术。采用Harris髋关节评分、髋关节伤残和骨关节炎(HOOS)评分评估患者髋关节功能和生活质量,统计术中出血量、手术时间、术后并发症。结果所有患者均得到随访,平均随访时间(17.13±5.03)个月。15例患者在旷置期间未发生间隔器脱位、断裂等并发症,旷置术后平均(3.79±1.07)个月行髋关节二期翻修术。二期翻修术中所有间隔器均易于移除,骨缺损程度与旷置术后相比未见明显变化。1例患者髋关节二期翻修术后1个月脱位,行闭合复位后功能良好,随访期间15例患者均无感染复发、假体松动等并发症。15例患者旷置术后1个月、二期翻修术前及末次随访Harris髋关节评分分别为(58.30±4.57)分、(76.85±6.89)分和(89.47±3.60)分,较旷置术前Harris髋关节评分[(43.41±3.11)分]提高(P<0.05)。15例患者旷置术后1个月、二期翻修术前及末次随访HOOS评分分别为(260.30±7.52)分、(339.45±14.75)分和(380.78±8.40)分,较旷置术前HOOS评分[(253.62±10.47)分]提高(P<0.05)。结论高光面抗生素骨水泥间隔器制备过程简便,在根除感染的同时,能有效改善患者旷置期间关节活动功能、减轻疼痛、提高其生活质量、保留骨量,为二期翻修创造有利条件。Objective To investigate the early efficacy of highly-polished antibiotic-loaded articulating cement spacer in treating periprosthetic hip joint infection.Methods Fifteen patients with periprosthetic joint infection after hip arthroplasty diagnosed in our hospital between August 2018 and December 2019 were included.A highly-polished antibiotic-loaded articulating cement spacer was used in the first-stage operation.The second-stage hip revision was performed on patients who were free from infection after an effective anti-infective therapy.The hip function and quality of life were assessed based on the Harris Hip Score(HHS)and Hip Disability and Osteoarthritis Outcome Score(HOOS).The intraoperative blood loss,operative duration and postoperative complications were also evaluated.Results The follow-up time for all the patients was(17.13±5.03)months,and none of the patients had spacer dislocation and rupture or other complications before the second-stage hip revision,which was performed(3.79±1.07)months after the first-stage operation.All spacers were easy to remove during the second-stage hip revision,and the degree of bone defect was not different from that following the first-stage operation.Dislocation occurred in one patient after the second-stage revision,who was functionally recovered after a closed reduction.There was no recurrence of infection,prosthesis loosening,or other complications in all the patients during the follow-up.The HHS was(58.30±4.57),(76.85±6.89),and(89.47±3.60)at 1 month after the first-stage operation,before the second-stage hip revision,and the last follow-up,respectively,and was higher at these time points compared with that before the first-stage surgery(43.41±3.11)(P<0.05).The HOOS was(260.30±7.52),(339.45±14.75),and(380.78±8.40)at 1 month after the first-stage operation,before the second-stage hip revision,and the last follow-up,respectively,and was also significantly increased at these time points relative to that before the firststage surgery(253.62±10.47)(P<0.05).Conclus

关 键 词：髋关节置换术 髋关节假体周围感染 二期翻修 高光面间隔器 

分 类 号：R687.4[医药卫生—骨科学]