自制关节型抗生素骨水泥占位器在人工髋关节置换术后感染二期翻修中的应用

Antibiotic-loaded cement articulating spacer made by a self-made mold system in the treament of the infected hip replacement

目的 总结使用自制压模器制成的关节型抗生素骨水泥占位器在人工髋关节置换术后感染二期翻修中应用的经验与教训,评价其在髋关节置换术后感染二期翻修中的效果和作用.方法 2005年8月至2009年12月采用二期翻修治疗的髋关节置换术后感染的患者中,127例患者在一期彻底清除后,植入了使用自制压模器术中制成的关节型抗生素骨水泥占位器,待感染控制后行二期翻修.其中106例患者107髋获得随访.观察使用这种占位器控制感染的有效率,制作、植入及取出的方便程度和出现的并发症,特殊情况的使用,观察患者的功能和满意程度.结果 106例患者平均随访时间34.3个月（3～55个月）,一次感染控制率为96.3%,经过二期翻修末次随访时感染控制率为94.4%.占位器柄断裂4.7%,脱位率为2.8%,二期翻修时占位器取出困难者14.0%.患者满意率为93.5%.结论 使用自制压模器制成的关节型抗生素骨水泥占位器在人工髋关节置换术后感染的二期翻修治疗中,具有制作简单、重复性好、感染控制率高、保留关节功能好、患者满意率高等优点,通过改进方法后可以减少断裂及取出困难问题,结合使用金属内固定或异体骨不会影响感染的控制率.

Objectives To summarize the experience and lessons of the using of antibiotic-loaded cement articulating spacer made by a self-made mold system for the treament of the infected hip replacement, and to evaluate its efficiency and role in the two-stage revison of infected total hip arthroplasty （THA）. Methods The patients with infected THA treated with two-stage revision protocol from August 2005 to December 2009 were reviewed. All of the 127 patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer made by a self-made mold system; Two-stage revisions were not followed until] the infection were controlled. Among of them, 106 patients, 107 hips were gotten fully followed up. Evaluations were made for the efficiency of infection control, convenience of making, implantating and removing of the spacers, occurrence of complications, the deal of the special circumstances, the function and satisfaction of the patients. Results The 107 hips were gotten an average of 34. 3 months＇ （3-55 months） follow-up. The infection control rate was 96. 3% after the first-stage surgery, the infection control rate was 94.4% at last follow-up after two-stage revisions. The breakage rate of the spacer was 4.7% , dislocation rate was 2. 8% , removal of the spacers with difficulty were seen in 15 patients （ 14.0% ）. The satisfactory rate of the patients was 93. 5% . Conclusions Antibiotic-loaded cement articulating spacer made by a self-made mold system is an effective methods for the two-stage revision of the infected hip replacement, characterized by simple, good reproducible, high rates of infection control, better joint function after surgeries, high rate of patients satisfaction and other advantages. And it can decrease the complications, such as the breakage, spacer dislocation of hip joint and difficulty in removeral of spacer at the second stage revision. Using of metallic internal fixation or allograft bone combined with spacer does not affect the results of infection controlling.