全髋置换术治疗感染后髋关节退变7例

Total hip arthroplasty for degeneration of infected hip:a report of 7 cases

目的:探讨采用全髋关节置换术治疗感染后髋关节退变的适应证和临床疗效。方法:7例有既往髋关节感染病史的髋关节退变,男5例,女2例;年龄30～65岁,平均45.8岁;感染静息期均达10年以上,平均19.5年。术前采用Kim方法评估髋关节畸形的严重程度,其中I型3例,Ⅱ型4例。术前主要依据体格检查以及检测血沉和C反应蛋白来排除活动性感染。手术采用髋外侧切口,彻底切除关节周围的瘢痕组织,松解软组织,全部选择非骨水泥固定的髋臼假体和股骨假体。采用Harris评分系统评价手术前后髋关节的功能。结果:术后随访21～44个月,平均33.5个月。所有病例无感染复发、下肢神经功能损伤或深静脉栓塞形成等并发症。到末次随访,平均Harris评分由术前平均44.5分提高到84分,没有出现假体的松动,或明显的假体周围骨溶解。结论:全髋关节置换术治疗感染后的髋关节退变,近期临床疗效满意。但要严格掌握手术适应证,以及术前排除活动性感染的可能。

Objective ：To evaluate indications and clinical results of total hip arthroplasties for degenerative hips with history of infection. Methods： Seven cases of degenerative hip with history of infection underwent primary total hip arthroplasties, which involved 5 males and 2 females, with an average age of 45.8 years （range, 30 to 65 years）. The quiescent period of infection were more than 10 years in all hips. According to Kim classification, 3 cases were of type Ⅰ, and 4 of type Ⅱ. The method to exclude active infection at the site of degenerative hips preoperatively was combination of physical examination,erytbrocyte sedimentation rate and C-reactive protein level. The lateral incision was adopted in all cases, and all prosthesis were cementless. The clinical results of affected hips were assessed according to Harris hip score. Results：The follow-up was performed with the mean duration of 33.5 months （range, 21 to 44 months ）. No recurrence of infection, damage of nerve function or deep vein thrombosis of lower extremities occurred in all cases. The mean Harris hip scores improved from 44.5 points preoperatively to 84 points at the latest follow-up. No aseptic loosening of prosthesis or periprostbetic osteolysis were found at the latest followup. Conclusion： Total hip arthroplasties has good short term results for degenerative hips with history of infection. It is important to select indicated cases and rule out the possibility of active infection.