二期人工全髋关节翻修术治疗慢性化脓性髋关节炎的疗效分析  

Two-stage total hip arthroplasty for chronic septic hip arthritis

作　　者：张超凡[1] 方心俞[1] 黄子达[1] 白国昌[1] 张泽宇 杨烨 张子杰 李文波[1] 张文明[1] Zhang Chaofan;Fang Xinyu;Huang Zida;Bai Guochang;Zhang Zeyu;Yang Ye;Zhang Zijie;Li Wenbo;Zhang Wenming(Department of Orthopaedic Surgery,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院骨科,福州350005

出　　处：《中华创伤骨科杂志》2021年第12期1063-1070,共8页Chinese Journal of Orthopaedic Trauma

基　　金：福建省卫生健康中青年骨干人才培养项目(2019-ZQN-57);福建省自然科学基金项目-对外合作项目(2020I0015);福建省科技创新联合资金项目(2019Y9122);2019-2020福建省卫生健康突出贡献中青年专家课题。

摘　　要：目的探讨二期人工全髋关节翻修术治疗慢性化脓性髋关节炎的疗效。方法回顾性分析2008年1月至2020年3月期间福建医科大学附属第一医院骨科采用二期翻修术治疗的17例(17髋)慢性化脓性髋关节炎患者资料。男11例,女6例;平均年龄为54.5岁(19~77岁);左髋9例,右髋8例;10例为原发化脓性髋关节炎,7例为髋部手术后继发感染。3例患者已于外院行清创手术,1例患者窦道形成。一期手术进行彻底清创,切除病变的股骨头、颈,植入关节型间隔器;二期手术取出间隔器,16例患者植入生物型人工全髋关节假体,1例患者植入骨水泥型人工全髋关节假体。记录患者的微生物培养结果、手术时间、术中出血量及治疗结果等。结果13例患者获得病原学资料,其中4例患者培养呈阴性。2例培养阴性患者采用宏基因组二代测序检出病原菌。本组患者一期手术时间平均为140.6 min(90~176 min),术中出血量平均为361.8 mL(100~1000 mL);二期手术时间平均为130.3 min(91~166 min),术中出血量平均为291.2 mL(50~700 mL)。一期至二期手术的间隔时间平均为115.0 d(66~227 d),期间1例患者出现间隔器断裂,1例患者出现间隔器脱位,1例患者合并下肢深静脉血栓形成。所有患者二期手术后获12~82个月(平均36.7个月)随访。17例患者炎症指标均已降至正常,无一例患者感染复发。结论二期翻修术治疗慢性化脓性髋关节炎的成功率较高。规范的外科清创技术、采用多种方法明确病原微生物并针对性地应用敏感抗生素,是治疗成功的关键。Objective To analyze the clinical efficacy of two-stage total hip arthroplasty in the treatment of chronic septic hip arthritis.Methods From January 2008 to March 2020,17 patients with chronic septic hip arthritis(17 hips)received two-stage total hip arthroplasty at Department of Orthopaedic Surgery,The First Affiliated Hospital to of Fujian Medical University.They were 11 males and 6 females,with an average age of 54.5 years(from 19 to 77 years)and 9 left and 8 right hips affected.There were 10 cases of primary septic hip and 7 cases of secondary infection after hip surgery.Three patients had undergone debridement in other hospitals and one patient had developed a sinus tract.In the first stage operation,the diseased femoral head and neck were resected to implant an articulating spacer after thorough debridement;in the second stage operation,the spacer was removed to implant a uncemented artificial hip prosthesis in 16 cases or a cemented artificial hip prosthesis in one case.Recorded were the results of microbial culture,operation time,intraoperative blood loss,and therapeutic outcomes of the patients.Results Pathogenic data were available in 13 patients and the culture was negative in 4.The pathogens were detected by metagenomic next-generation sequencing in 2 patients with culture negative.In the first stage operation,operation time averaged 140.6 min(from 90 to 176 min)and intraoperative blood loss 361.8 mL(from 100 to 1000 mL);in the second stage operation,operation time averaged 130.3 min(from 91 to 166 min)and blood loss 291.2 mL(from 50 to 700 mL).The average interval between the first and the second stage operations was 115.0 days(from 66 to 227 d).During the interval,spacer fracture occurred in one case,spacer dislocation in one case and lower extremity deep venous thrombosis in one case.All the patients were followed up for 12 to 82 months(average,36.7 months)after second stage operation.The inflammatory indexes decreased to normal in all the 17 patients and infection recurrence was observed in none o

关 键 词：骨关节炎 髋 慢性病 病原学 化脓性髋关节炎 二期翻修 

分 类 号：R687.4[医药卫生—骨科学]