含抗生素骨水泥占位器在髋关节置换后感染二期翻修中的应用

Application of antibiotic-loaded bone cement spacer in second-stage revision for infected total hip arthroplasty

背景：感染是髋关节置换后灾难性的并发症,其治疗方法很多,但是二次翻修是公认的疗效比较肯定的方法。目的：回顾分析含抗生素骨水泥占位器在髋关节置换后感染二期翻修过程中的应用效果。方法：在26例（27髋）髋关节置换后感染患者的二期翻修过程中使用含抗生素骨水泥占位器,置入原假体的位置,制作时,在占位器中央放入一根斯氏针作为支架。治疗后随访并行Harris评分。结果与结论：1例患者因治疗后不恰当负重活动导致占位器断裂,取出骨水泥占位器,行清创后关节旷置。其余25例患者均获得随访,随访时间1~7年。患者治疗后Harris评分平均为90.2分,较治疗前平均改善61.9分,感染控制率为96.3%。提示在使用含抗生素骨水泥占位器的基础上使用二期翻修治疗髋关节置换后感染,具有感染控制率高,置换后关节功能良好等优点。

BACKGROUND： Infection is one of the most serious complications of total hip arthroplasty （THA） surgery, although there are many ways can treat the infection, secondary revision procedures is recognized as an effect treatment method. OBJECTIVE： To retrospectively study the effect of antibiotic-loaded bone cement spacer in second-stage revision for infected THA. METHODS： Totally 27 hips from 26 cases who infected after THA were treated with two-stage revision using antibiotic-loaded bone cement spacer to instead the position of original prosthesis. During this procedure, a steinmann pin was load in the center of the spacer as scaffold. All the cases were followed up after the surgery and Harris score was evaluated. RESULTS AND CONCLUSION： Due to improper weight-bearing activities after surgery, the spacer of one case was ruptured, after removal of the bone cement spacer and debridement, the joint was spacious placed. The other 25 cases were all followed up for 1 to 7 years. After surgery, the mean Harris hip score reached 90.2 which improved 61.9 as compared with before operation, and the cure rate was 96.3%. It is indicated that infected THA can be successfully treated by two-stage revision surgery with antibiotic-loaded bone cement spacers, and has the advantage of higher infection control rate and joint function recovery.