一期和二期翻修治疗人工髋关节置换术后感染的比较

Comparision of treating infection after total hip replacement between one-and two-stage revision procedure

目的通过对比采用一期翻修和二期翻修治疗人工髋关节置换术后感染的结果和经验,为临床选择治疗方案提供参考。方法对收治的人工髋关节置换术后感染病例,采用一期翻修治疗13例,采用二期翻修治疗15例16髋,对上述病例进行总结。结果一期翻修患者平均随访54个月(24～144个月),其中4例患者在术后2年内感染复发,行切除成形术治愈。其中2例为金黄色葡萄球菌感染,1例为阴沟肠杆菌感染,1例为表皮葡萄球菌感染。其余患者在最后随访时感染没有复发,1例患者10年后因假体松动翻修。二期翻修病例平均随访时间28.3个月(5～84个月),所有患者均无感染复发。5例一期翻修成功患者的Harris评分平均为89.2(76～96),较治疗前改善41.2分,优2例,良2例,可1例。二期翻修患者Harris评分平均85.1分(57～98分),较治疗前改善54.9分。优7例,良6例,可1例,差1例。结论一期翻修只能适用于少数患者,应严格掌握适应证;二期翻修更安全可靠,适用于绝大多数患者。

Objective To compare the treatment of infection after total hip replacement between one-and two-stage revision procedure, and provide some references for clinical choice. Methods Total 28 patients （29 hips） with infection following a hip arthroplasty were analyzed respectively. 13 cases were treated by one-stage revision and the others （16 hips） were treated by two-stage revision. Results The mean follow-up after revision was 36 months for onestage revision cases and 28.3 months for two-stage revision cases. Four cases of one-stage revision were failed and treated by resection arthroplasty. The other cases were with no recurrence of infection. All two-stage revision cases were with no recurrence of infection. The mean postoperative Harris Hip Score averaged 89.2 points of one-stage revision cases and 85.1 （57 - 98 ） points of two-stage revision cases. Conclusion Two-stage reconstruction of the infected hip is preferred to one-stage exchange arthroplasty because of its higher rate of eradication of the infection.