万古霉素磷钙骨水泥在人工髋关节置换术后感染二期翻修术中作用的实验研究

Effect of vancomycin-impregnated calcium phosphate cement in two-stage revision for management of infection after hip arthroplasty

[目的]建立兔人工髋关节置换术后感染动物模型,探讨万古霉素磷酸钙骨水泥(VCMCPC)在人工全髋关节置换术后感染二期翻修术中的作用。[方法]新西兰大白兔60只,行人工髋关节置换术,术毕将含有1×108CFU耐甲氧西林表皮葡萄球菌株的明胶海绵即刻置入至左侧髋关节内,建立兔人工髋关节置换术后感染模型。术后4周清创,植入药物缓释材料,间隔6周后行二期置换术,观察万古霉素磷酸钙骨水泥在人工全髋关节置换术后感染二期翻修术中的作用。[结果]耐甲氧西林表皮葡萄球菌株接种后4周后所有动物的左侧髋关节均感染。二期再植和处死前各组感染率均下降,VCMCPC、VCMPMMA组感染率控制满意,而与对照组比较差异显著。[结论]载药CPC在人工髋关节置换术后感染二期翻修术中能明显降低感染复发率,可提高翻修成功率。

[ Objective] To study the effects vancomycin-impregnated calcium phosphate cement（ VCM-CPC ） on the management of infection in the two-stage revision for the infection after hip arthroplasty. [ Method] Gelatin sponge , having methicillinresistant staphylococcus epidermidis（MRSE） of 1 × 10^8 CFU, was implanted in the left hip of 60 rabbits after the hip arthroplasty. The animal model of infected hip arthroplasty was established in rabbits. Debridement was performed four weeks later, the carrier material for VCM was implanted, and two-stage revision arthroplasty was performed after 6 weeks. Effects of VCM-CPC on the management of infection in the two-stage revisions were observed. [ Result ] All left hip joints of animals were infected 4 weeks after MRSE. The rate of intbction decreased at replantation and before sacrificed and the infection control decreased significantly for group VCM-CPC, VCM-PMMA, as compared with that for the control group. [ Conclusion ] The drug-impregnated CPC can obviously decrease the rate of reinfection and increase the success rate of two-stage revisions to treat the infection after the hip arthroplasty.