人工髋关节置换术后感染的治疗对策(Ⅱ期翻修手术治疗初探)

Clinical study on second-stage revision in the postoperative infection after total hip replacement

目的:探讨Ⅱ期翻修手术治疗在全髋关节置换术后感染的疗效和临床体会,以及该技术的安全性和有效性。方法:2003年1月至2011年3月,采用Ⅱ期翻修手术治疗7例(7髋)髋关节疾患,男5例,女2例;年龄42～68岁,平均51.5岁。7例患髋均有不同程度疼痛;关节液或假体周围组织细菌培养,6例阳性,1例阴性;术中所有患者假体周围组织病理检查发现急性炎症;2例出现与假体相通的窦道;7例血沉增快及C反应蛋白增高;5例X线片有骨融解、假体松动及骨膜反应等表现。所有病例采用Ⅱ期翻修手术治疗,Ⅰ期手术彻底清创,取出假体,以含万古霉素的骨水泥假体临时旷置,术后静脉输入抗生素4周后,改为口服抗生素6周。术后定期复查血沉和C反应蛋白,待结果正常后再Ⅱ期行人工髋关节翻修术。结合手术前后患者髋关节Harris评分,对人工髋关节置换术后感染的Ⅱ期翻修手术治疗进行分析。结果:所有患者获随访,时间12～36个月,平均19.5个月,术后X线片显示关节假体位置正确。结论:Ⅱ期翻修手术治疗人工髋关节置换术后感染具有疗效良好、安全可靠等优点,其为人工髋关节置换术后感染的治疗提供一种可靠的选择。

Objective： To study the therapeutic effects and clinical experiences of second stage revision in postoperative infection after total hip replacement and to explore its security and validity. Methods： From January 2003 to March 2011, 7hips inl7 patients （5 males and2 females, ranging in age from 42 to 68 years, with an average of 51.5 years） were treated with second stage revision. All the patients suffered from different degrees of hip pain. In bacilliculture of Synovial fluid or periton - sillar tissue, 6 patients showed positive resuhs and 1 patient negative. The intraoperative periprosthetic histopathological ex - amination showed that all the pa- tients had acute inflammation. Eight patients had sinus communicating with prosthesis ; 7 patients had increased ESR, and 7 patients had C reactive protein increased. All the patients had osteolysis , prosthesis loosening, and the performance of periosteal reaction in X ray. All the patients were treated with second stage revision. In the first operation, thorough debridement was perfumed and the pros- thesis was removed. Then the prosthesis of antibiotic --loaded acrylic cement was implanted. After giving antibiotics intravenously for 4 weeks , the antibiotics were taken orally for another six weeks. The ESR and C response protein were examined at regular time, and the second stage revision surgery was perfumed when the ESR and C response protein were normal. Results： All the patients were fol- lowed up with an average of 19. 5 months, ranged from 12 to 36 months. No complications occurred. Postoperative X ray showed pros- thesis in the correct position. Conclusion： The second stage revision in postoperative infection after total hip replacement has a good ef- ficacy , safety and reliability advantages. This technology provides an alternative in postoperative infection after total hip replacement.