初次人工髋关节置换中应用复合抗生素骨水泥的作用

Application of antibiotic-loaded bone cements in primary hip arthroplasty

背景：在初次骨水泥固定的人工髋关节置换中,抗生素骨水泥能否起到预防伤口深部感染的作用,目前存在着争议。目的：回顾性观察初次人工髋关节置换中应用抗生素骨水泥的作用。设计、时间及地点：回顾性病例分析,2004-02/2007-01在北京大学第三医院骨科连续进行的使用抗生素骨水泥固定的初次人工髋关节置换病例。对象：连续使用同一种抗生素骨水泥固定假体的人工髋关节初次置换者227例233髋,其中184例191髋获得3-46个月的随访,男69例,女115例。方法：人工股骨头置换54例,均为≥71岁的老年股骨颈骨折患者。人工全髋关节置换130例。17例髋臼侧用金属网,自体＋异体松质骨颗粒行打压植骨,行髋臼成型术。3例髋臼侧行结构性植骨术。髋臼侧、股骨侧假体均使用抗生素骨水泥（Refobacin-PalacosR40或CemexGenta）。主要观察指标：术后伤口发生深部感染的情况。结果：接受人工假体置换的227例233髋住院期间未发生早期伤口深部感染。184例191髋随访期内未出现伤口深部感染。其中15例置换关节处红肿、或皮温升高、或关节周围疼痛的病例,均行血沉及C反应蛋白检查。12例血沉正常,3例升高患者中1例为类风湿患者,1例为老年性慢性支气管炎患者,另1例原因不明,1个月后复查正常。14例患者C反应蛋白在正常范围以内,1例患者C反应蛋白升高为类风湿性关节炎,6周后复查正常。结论：初次人工髋关节置换中可以应用抗生素骨水泥预防伤口深部感染的发生。

BACKGROUND： It is still controversial whether antibiotic-loaded bone cement can prevent wound deep infection in the primary hip arthroplasty. OBJECTIVE： To retrospectively observe the effect of antibiotic-loaded bone cements in primary hip arthroplasty. DESIGN, TIME AND SETTING： A retrospective case analysis was performed for the patients undergoing primary hip arthroplasty at Department of Orthopedics, Peking University Third Hospital from February 2004 to January 2007. PARTICIPANTS： 227 consecutive patients （233 hips） underwent primary hip arthroplasty with the same antibiotic-loaded bone cement, including 69 male and 115 female, and 184 cases （191 hips） were followed up for 3-46 months. METHODS： Fifty-four patients over 71 years old with femoral neck fracture were treated with bipolar femoral head replacement. 130 patients underwent total hip arthroplasty. Seventeen patients with massive acetabular bone defect were reconstructed with impaction autogenous and heterogenous bone grafting plus mesh; 3 patients underwent acetabular structural bone grafting. Both acetabular and femoral side prosthesis were antibiotic-loaded bone cements （Refobacin-Palacos R 40 or Cemex Genta）. MAIN OUTCOME MEASURES： Deep infection after operation. RESULTS： 227 patients （233 hips） did not develop early deep infection after surgery. 184 cases （191 hips） did not occur deep infection during the follow up. However, 15 cases developed swelling on the affected site or skin temperature increase, or pain surrounding joint, and underwent blood sedimentation and C-reactive protein examinations; 12 cases had normal blood sedimentation and 3 had increased blood sedimentation including 1 with rheumatoid, 1 with senile chronic bronchitis, and 1 with undetermined cause. All the 3 patients restored one month later. Fourteen patients had C-reactive protein within normal scope, and 1 with increased C-reactive protein caused by rheumatoid arthritis, but restored 6 weeks later. CONCLUSION： Antibiotic-loaded bone cements in primary hip arthroplasty can reduce incidence of deep infection.