关节置换术后深部感染的诊断和治疗

Management of the infected total hip or knee arthroplasty with two-staged revisions

目的分析并总结人工关节置换术后深部感染患者的诊断和治疗经验,为临床应用提供参考。方法自2008年6月至2010年8月,采用二期翻修术治疗人工关节置换术后深部感染患者14例,男7例,女7例;髋8例,膝6例。原发疾病包括:骨性关节炎4例,骨肉瘤3例,股骨颈骨折6例,股骨头无菌性坏死1例。所有患者一期彻底清创,平均旷置间隔时间4个月(3～8个月)后行二期翻修重建术。术后定期随访。结果髋关节Harris评分由术前平均48.86分提高到术后平均82.9分;膝关节AKS评分由术前平均42.5分提高到84.25分;总计优良率为86.7%(≥80分)。仅1例翻修术后2年感染复发,感染总控制率为92.9%;1例患者(髋)在二次手术中均发生骨折。结论二期翻修术在感染控制和功能结果方面均为满意,应作为人工髋关节置换术后深部感染的常用治疗方法。

Objective To present our experience for the management of the infected hip and knee arthroplasty with two-staged revision. Methods Between June 2008 and Aug 2010 the replacement of the infected arthroplasty in two stages was performed in 14 patients. The mean follow-up time after revision was 16.6 months. Results One of 14 patients had a recurrence of the infection..One case had femoral fracture. The revision increased the Harris Hip Score from 48.9 points preoperative to 82. 9 （44 - 95 ） points postoperative, and the postoperative AKS averaged 84. 25 points and increased about 41.75 points more than preoperative. Conclusions Two-stage reconstruction of the infected hip and knee is useful and effective because of higher rate of eradication of the infection and good postoperative functional results in treating infected THA or TKA.