全髋关节置换术后延迟感染的二期翻修

Prothetic revision in two stages on delayed infected total hip arthroplasty

目的全髋关节置换术(THA)后感染中延迟感染比例较高,治疗困难。该文着重探讨这类感染病例二期翻修的方法。方法对2000年至2004年20例THA后延迟感染病人进行回顾性分析。其中男8例,女12例,平均年龄57．2岁(48-72岁)。细菌培养3例阳性,17例阴性;起病距初始手术平均7．1个月(3-20个月);一期手术前血沉和C反应蛋白(CRP)均明显增高。所有病例均采用一期彻底清创、假体取出和二期翻修的方法。间隔期内每周监测血沉和CRP,二次翻修术前停用抗生素至少2周。结果一期术后6周内所有病人血沉和CRP均降至正常。16例病人间隔期为8-9周,4例为15-19 周。翻修术后细菌培养均为阴性。平均随访28．6个月,无一例感染复发。Harris评分较术前平均提高 52．3分(P<0．01)。结论一期手术彻底清创、血沉和CRP监测及合适的二期翻修时机是成功控制 THA后延迟感染的关键,可获得满意的临床疗效。

Objective Delayed infection is conmaon in the postoperation infection after total hip arthroplasty （THA） and often difficultly treated. This topic is mainly to discuss the therapeutic method of this type of infection with prothetic revision in two stages. Methods 20 cases of postoperative delayed infection after THA were studied retrospectively from 2000 to 2004. There were 8 males and 12 females with an average age 57. 2 years （range, 48-72 years）. Only three cases had positive results in the bacterial cultures, others were negative. All patients were chronic onset with an average 7. 1 months （range, 3-20 months） after initial THA and the high serum levels of erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） were found before the primary surgery. Complete debridement, removal of infected prothesis and secondary reimplantation were carried out in all cases. Between stages, the serum levels of ESR and CRP were checked every week and were followed at least 2 weeks without antibiotics before the secondary surgery. Results The serum levels of ESR and CRP decreased to normal in all patients in 6 weeks after the primary surgery. The interval between primary and secondary procedures was 8-9 weeks in 16 cases and 15-19 weeks in other 4 cases. The bacterial cultures after secondary surgery were negative in all case. No recurrence was found with the mean follow up of 28, 6 months Mean Harris score increased 52. 3 after revision significantly （P〈0. 01）. Conclusions The success of the protocol to control the delayed infection after THA were three factors： complete debridement during the primary surgery, monitor of the serum levels of ESR and CRP, and the proper occasion of the secondary reimplantation. The clinical results are excellent.