采用硫酸钙载抗生素系统联合髋关节翻修术治疗髋关节置换术后假体周围感染的疗效分析  

Calcium sulfate-loaded antibiotic system combined with hip revision in the treatment of periprosthetic infection after hip arthroplasty

作　　者：王雨辰[1] 朱文科 俞伟忠[1] Wang Yuchen;Zhu Wenke;Yu Weizhong(Department of Orthopedics and Traumatology,Changzhou Wujin Traditional Chinese Medicine Hospital,Changzhou 213161,China)

机构地区：[1]常州市武进中医医院骨伤科,213161

出　　处：《骨科临床与研究杂志》2024年第3期170-175,共6页Journal Of Clinical Orthopedics And Research

基　　金：国家骨科与运动康复临床医学研究中心创新基金(2021-NCRC-CXJJ-PY-28);常州市青苗人才项目(CZQM2020121);江苏省中医药管理局科技项目(QN202221)。

摘　　要：目的探讨硫酸钙载抗生素联合髋关节翻修术治疗髋关节置换术后假体周围感染(PJI)的临床疗效。方法回顾性分析2018年1月至2021年10月间常州市武进中医医院骨伤科收治的髋关节置换术后假体周围感染患者12例,其中男8例,女4例;年龄56~76岁(64.9±6.0)岁;其中全髋关节置换术后感染10例,股骨头置换术后感染2例。本组术后出现感染症状距离首次置换时间1~120(15.2±33.4)个月。记录患者术前和术后末次随访时白细胞计数、血沉及C-反应蛋白,改良髋关节Harris评分(mHHS)及髋关节结果(HOS)评分。结果12例患者随访时间为12~23(17.2±6.7)个月。所有患者术后切口均按期愈合,未出现伤口持续渗液、异位骨化、感染复发等并发症。有1例出现无症状低钙血症。术中组织细菌培养有3例为阴性,9例为阳性,其中3例为金黄色葡萄球菌,3例为表皮葡萄球菌,2例为肺炎克雷伯菌,1例为粪肠球菌。末次随访时白细胞计数、血沉及C-反应蛋白较术前均有显著下降(P<0.05)。末次随访时mHHS评分及HOS评分较术前均有显著上升(P<0.05)。结论在髋关节置换术后PJI治疗中,翻修手术配合硫酸钙载抗生素系统能够取得良好的临床效果,对感染的控制和关节功能的康复作用明显,符合加速康复的理念。Objective To investigate the clinical efficacy of calcium sulfate-loaded antibiotics combined with hip revision in the treatment of periprosthetic infection after hip arthroplasty.Methods The study is a retrospective study.A total of 12 patients with periprosthetic infection after hip arthroplasty who were admitted to the Department of Orthopedics and Traumatology of Wujin Traditional Chinese Medicine Hospital in Changzhou from January 2018 to October 2021 were selected,including 8 males and 4 females;aged 56-76 years,mean(64.9±6.0)years old,including 10 cases of infection after total hip arthroplasty and 2 cases of infection after femoral head replacement.The postoperative infection symptoms in this group were 1-120 months from the first replacement time,with an average of(15.2±33.4)months.The white blood cell count,erythrocyte sedimentation rate,C-reactive protein,modified Hip Harris score(mHHS)and hip outcome(HOS)score were recorded before surgery and at the final follow-up after surgery.Results 12 patients in this group were followed up for 12-23 months,with an average of(17.2±6.7)months.The incisions of all patients healed as scheduled,and there were no complications such as continuous wound exudation,heterotopic ossification,and recurrence of infection.1 case developed asymptomatic hypocalcemia.Intraoperative tissue bacterial culture was negative in 3 cases and positive in 9 cases,including 3 cases of Staphylococcus aureus,3 cases of Staphylococcus epidermidis,2 cases of Klebsiella pneumoniae,and 1 case of Enterococcus faecalis.At the final follow-up,the white blood cell count,erythrocyte sedimentation rate and C-reactive protein were significantly lower than those before operation,and the difference was statistically significant(P<0.05).The mHHS score and HOS score at the final follow-up were significantly higher than those before operation,and the difference was statistically significant(P<0.05).Conclusion In the treatment of PJI after hip arthroplasty,revision surgery combined with calcium sulfate-loa

关 键 词：硫酸钙 假体周围感染 髋关节置换 

分 类 号：R683.4[医药卫生—骨科学]