保留假体清创联合更换组配式部件治疗全髋关节置换后急性假体周围感染  

Debridement,antibiotics,and implant retention combined with replacement of assembled components in treatment of acute prosthetic joint infection after total hip arthroplasty

作　　者：潘希安 张远金[1] 张国富[1] 李俊[1] 刘炳霞 周定康 孙法瑞[1,2] Pan Xian;Zhang Yuanjin;Zhang Guofu;Li Jun;Liu Bingxia;Zhou Dingkang;Sun Farui(Department of Orthopedics,Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic University),Huangshi 435000,Hubei Province,China;Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention,Huangshi 435000,Hubei Province,China;Department of Ultrasound Imaging,Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic University),Huangshi 435000,Hubei Province,China;Department of Surgical Anesthesiology,Huangshi Central Hospital(Affiliated Hospital of Hubei Polytechnic University),Huangshi 435000,Hubei Province,China)

机构地区：[1]黄石市中心医院(湖北理工学院附属医院)骨科,湖北省黄石市435000 [2]肾脏疾病发生与干预湖北省重点实验室,湖北省黄石市435000 [3]黄石市中心医院(湖北理工学院附属医院)超声影像科,湖北省黄石市435000 [4]黄石市中心医院(湖北理工学院附属医院)手术麻醉科,湖北省黄石市435000

出　　处：《中国组织工程研究》2025年第21期4499-4505,共7页Chinese Journal of Tissue Engineering Research

基　　金：湖北省自然科学基金(2023AFB1071),项目负责人:潘希安;湖北理工学院校级科研项目(22xjz06W),项目负责人:潘希安。

摘　　要：背景:全髋关节置换后假体周围感染是影响假体使用寿命的常见原因,保留假体清创联合更换组配式组件成为治疗全髋关节置换后急性期假体周围感染的新方法。目的:观察采用保留假体清创联合更换组配式部件治疗人工全髋关节置换后急性期假体周围感染的临床疗效。方法:选择2018年7月至2022年2月在黄石市中心医院骨科进行手术治疗的22例初次全髋置换后急性期假体周围感染患者,所有患者感染时间均为初次置换3周以内,术中取关节液及感染滑膜行细菌培养均证实为急性期感染,采用保留假体清创联合更换组配式组件治疗。术前、术后3,6个月以及末次随访,以白细胞计数、血沉、C-反应蛋白评价感染情况,以Harris髋关节功能评分量表评价髋关节功能改善情况,以疼痛目测类比评分了解患者疼痛缓解情况,采用配对样本t检验分析手术前后各指标改善情况。结果与结论:(1)非假体周围感染原因死亡1例后失访,予以排除,其余21例患者均获得临床随访,随访时间均在1年以上,平均随访时间为(19.52±3.88)个月,其中20例患者手术治疗成功,1例失败,感染控制率为95%;(2)患者术后3,6个月以及末次随访的白细胞计数、血沉、C-反应蛋白水平均较术前下降(P<0.05),Harris髋关节功能评分均较术前提高(P<0.05),疼痛目测类比评分均较术前下降(P<0.05),差异均有显著性意义(P<0.05);(3)提示全髋关节置换后急性期假体周围感染患者选择保留假体清创联合更换组配式组件的治疗方法能有效控制髋关节感染,改善髋关节功能,缓解感染导致的髋部疼痛。BACKGROUND:Lifespan of prosthetic joint was being influenced by periprosthetic infection after total hip arthroplasty.Combination of debridement,antibiotics,and implant retention with the replacement of assembled components represents a novel approach in the management of acute prosthetic joint infection after total hip arthroplasty.OBJECTIVE:To observe the efficacy of debridement,antibiotics,and implant retention combined with the replacement of assembled components in the treatment of acute prosthetic joint infection after total hip arthroplasty.METHODS:Twenty-two patients with acute prosthetic joint infection after initial total hip arthroplasty at the Department of Orthopedics,Huangshi Central Hospital,China,between July 2018 and February 2022 were enrolled.The infection time of all patients was less than 3 weeks after the initial arthroplasty.Intraoperative joint fluid extraction and bacterial culture of infected synovium proved to be acute stage infection.They were treated using debridement,antibiotics,and implant retention combined with the replacement of assembled components.Infections were assessed using leukocyte count,erythrocyte sedimentation rate,and C-reactive protein levels before,3 and 6 months after surgery.Improvements in hip joint function were evaluated using Harris hip score.Pain relief was assessed using visual analog scale score.Paired sample t-test was used to analyze the improvement of each index before and after operation.RESULTS AND CONCLUSION:(1)One patient died of non-periprosthesis infection and was subsequently lost to follow-up,which was excluded.The remaining 21 patients received clinical follow-up,and the follow-up time was more than 1 year,with a mean follow-up time of(19.52±3.88)months.Among them,20 patients were successfully treated with surgery and 1 patient failed,and the infection control rate was 95%.(2)The levels of leukocyte count,erythrocyte sedimentation rate,and C-reactive protein were lower in 3 and 6 months after surgery(P<0.05);Harris hip function scores were high

关 键 词：全髋关节置换 保留假体清创 假体周围感染 组配式部件 髋关节功能评分 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学] R687