从髋关节假体的生存谈初期稳定和感染性松动的关系

RELATIONSHIP BETWEEN INITIAL STABILITY AND INFECTED LOOSENING OF TOTAL HIP ARTHROPLASTY PROSTHESIS

目的探讨人工全髋关节置换(total hip arthroplasty,THA)术后的初期稳定与假体感染性松动之间的关系。方法2000年1月-2008年12月,收治110例110髋THA术后需翻修者,其中15例为部分假体感染性松动。男8例,女7例;年龄42～75岁,平均62岁。初次关节置换术后6个月～2年出现感染症状,均为TsukayamaⅣ型、晚期感染。6例为单纯髋臼假体松动,其中5例一期、1例二期翻修髋臼;7例为单纯股骨假体松动,其中4例一期、3例二期翻修股骨柄;2例仅关节囊内感染、窦道形成,无假体松动,行关节清理和术后持续抗生素冲洗。结果术后切口均Ⅰ期愈合。15例均获随访,随访时间12～36个月,平均24个月。13例翻修者术后X线片示股骨柄和髋臼假体位置良好,无临床和影像学感染、松动征象。2例关节囊内感染者,术后6个月内窦道复发,但无髋关节疼痛,负重、行走及髋关节活动基本正常。Harris评分由术前平均42分提高至术后85分,获优4例,良7例,中4例。结论THA术后感染可为全关节、半关节或仅关节囊内感染;假体的初期稳定性将影响假体的长期生存率。如假体达初期稳定,即使存在感染,也将被局限。

Abstract： Objective To investigate the relationship between the initial stabil ity and infected loosening of the total hip arthroplasty （THA） prosthesis. Methods From January 2000 to December 2008, 110 cases （110 hips） were treated with THA revision. Among them, 15 cases （15 hips） were confirmed infected loosening. There were 8 males and 7 females with an average age of 62 years （range 42-75 years）. The infected signs were found from 6 months to 2 years after initial THA. All of them had Tsukayama type IV and late infection, including 6 cases of acetabular infected loosening （5 cases of one-stage and 1 case of two-stage acetabular revision）, 7 cases of simple infected loosening of femoral prosthesis （4 cases of one-stage and 3 cases of twostage femoral prosthesis revision）, and 2 cases of joint capsule infection and sinus without prosthesis loosening （debridement and continuous irrigation）. Results All incisions healed by first intention. Fifteen patients were followed up for 12 to 36 months （average 24 months）. In 13 cases of revision, postoperative X-ray films showed that femoral acetabular prostheses were in good position, and had no cl inical and imaging infective signs of loosening. In 2 cases of joint capsule infection, sinus recurred 6 months postoperation without hip joint pain, the function of weight-bearing and walking of hip joint was normal. Harris score increased from preoperative average of 42 to postoperative average of 85; the results were excellent in 4 cases, good in 7 cases, and fair in 4 cases. Conclusion The infection of THA may occur in the whole joint, half-joint or just in joint capsule. The initial stabil ity of the prosthesis would affect the long-term survival of the prothesis. If the prosthesis initial stabil ity is obtained, even if there are infective factors, infections would also be l imited.