13例人工髋关节翻修术的感染控制策略

Infection control strategy of hip arthroplasty rebuild operation in 13 cases

目的探讨人工髋关节置换并发感染后翻修时再次感染的控制策略。方法对13例人工髋关节置换后感染的患者进行关节腔穿刺和关节液细菌培养,Ⅰ期清创时取出假体及骨水泥,彻底切除关节囊瘢痕组织、坏死组织及明显充血水肿组织,与此同时取脓液或明显炎性组织进行细菌培养,在Ⅱ期翻修前分离出致病菌,使用敏感抗生素,确认感染被控制后进行Ⅱ期翻修。Ⅱ期翻修时置入含抗生素的骨水泥占位器4-6周,术后使用敏感抗生素。结果 13例患者中经术前穿刺和术中脓液或组织细菌培养有10例患者发现致病菌,经敏感抗生素治疗,感染被控制后Ⅱ期置入人工关节。随访6个月至10年,无关节感染复发,假体无明显松动或下沉,Harris评分由术前平均47.6±6.4增加到术后随访时的87.3±12.5（P〈0.01）。结论人工髋关节置换术后感染Ⅱ期翻修的关键环节是彻底清创的基础上根据细菌培养结果合理使用有效抗生素。

Objective To explore the infection control strategies of the hip arthroplasty rebuild operation.Methods 13 cases infected after artificial hip replacement were performed joint cavity puncturing and bacteria were isolated from joint fluid.Through primary debridment,the prosthesis and bone cement were removed,the scar and necrotic tissue were cleared,meanwhile,bacteria were isolated from inflarmatory tissues.Pathogenic bacteria needed to be identified for reasonable using antibiotics before the two-stage renovation.Bone cement spacers loaded with antibiotics were inputed for 4～6 weeks in two-stage renovation.Results 5 kinds pathogenic bacteria were found in 10 cases.Through treaments with sensitive antibiotics,the infection was controlled and two-stage hip arthroplasty was performed.During a follow-up period of 6 month to 10 years,there were no recurrent prosthetic infection and significant prosthesis loosening or subsidence.Harris score rised from 47.6±6.4（prooperative） to 87.3±12.5（postoperative）（P〈0.01）.Conclusion The key of two-stage renovation are the thorough debridement and reasonable using antibiotics according to the bacterial culture results.