人工髋关节置换术后感染二期翻修治疗的临床研究

Clinical research on the two-stage revision for postoperative infections of artificial hip replacement

目的探讨二期翻修治疗人工全髋关节置换术后感染的临床效果,以期提高临床治疗水平。方法回顾性分析2010年3月-2013年2月55例人工全髋关节置换术后感染患者,均采用一期手术彻底清创,取出感染假体,置入抗生素骨水泥间隔器,二期手术植入骨水泥型或非骨水泥型假体,分别对实验室检查、影像学检查和髋关节功能等方面进行比较分析。结果人工全髋关节置换术后感染患者二期翻修治疗后,Harris髋关节功能评分术前为(29.52±3.73)分、术后为(83.74±5.83)分,平均提高了(54.22±2.1)分,Harris评分优良率为92.73%;实验室检查中术前血沉为(38.53±8.93)mm/h、CRP为(65.94±34.95)mg/L,术后分别为(21.52±4.36)mm/h、(5.36±1.74)mg/L,而术前培养出病原菌55株,术后未检出,差异有统计学意义(P<0.05);在影像学上,术前假体下沉、松动、骨溶解、骨膜反应、内固定不稳等表现分布率,分别为61.82%、43.64%、23.64%、45.45%、16.36%,而术后均无假体下沉、松动、骨溶解、内固定不稳表现,差异有统计学意义(P<0.05)。结论二期翻修治疗人工全髋关节置换术后感染临床效果显著。

OBJECTIVE To investigate the clinical effect of two-stage revision for postoperative infections of artificial hip replacement, in order to improve the level of clinical treatment. METHODS A retrospective analysis on 55 cases of postoperative infection patients of total hip replacement during Mar. 2010 to Feb. 2013 were performed. All of them received thorough debridement in one-stage operation, infected implant removed, antibiotic bone cement spacer implanted, bone cement types or non- bone cement types implanted in two-stage operation. A comparative analysis from the laboratory tests, imaging studies, and hip function was taken. RESULTS After the two-stage revision for postoperative infection of total hip replacement, the average Harris hip score was （83. 74±5.83）, increased averagely （54.22±2. 1） than before （29. 52 ± 3.73） points, the ratio of excellent score of Harris was 92.730%. Preoperative laboratory tests erythrocyte sedimentation rate was （38.53± 8.93） mm/h, CRP （65.94±34.95）rag/L, respectively, after operation （21.52±4.36） ram/h, （5.36±1.74） mg/L, respectively. There were 55 strains of pathogens cultured before operation, while none after operation. The differences were significant（P〈0.05）. For the imaging, before operation, the distribution rates of prosthesis sinking, loosening, osteolysis, periosteal reaction and internal fixation instability were 61. 82%, 43. 64%, 23.64 %, 45.45% and 16.36 % respectively, and after operation none of these imaging conditions. The differences were significant（P〈 0. 05）. CONCLUSIONS The two-stage revision for postoperative infection of artificial hip replacement has a significant effect in clinic.