髋关节置换术后慢性感染伴窦道形成的手术治疗

Revision operations on chronically infected hip replacements with discharging sinuses

目的探讨髋关节置换术后慢性感染伴窦道形成的治疗方法。方法共10例髋关节置换术后慢性感染伴窦道形成患者,男6例,女4例,平均年龄59岁(48～65岁)。术前Harris评分平均31分(26～38分),血沉平均56mm/h(38～74mm/h)。所有病例术前、术中均进行细菌培养及药敏试验。10例患者中一期翻修8例,二期翻修2例。结果10例患者中术前细菌培养2例阴性,8例阳性,其中6例为表皮葡萄球菌,2例为G-细菌。术中细菌培养9例阳性,其中表皮葡萄球菌7例,G-细菌2例。根据术前细菌培养结果,6例表皮葡萄球菌感染患者及2例细菌培养阴性患者行一期翻修术,其余2例G-细菌感染患者行二期翻修术。术后平均随访19个月(8～30个月),感染均未再复发。术后血沉均恢复正常,Harris评分平均82.5分(78～89分),较术前平均提高50分(配对t检验,P<0.02)。结论髋关节置换术后慢性感染伴窦道形成者,一期翻修可以取得满意的临床疗效。慢性感染伴有窦道形成不应该作为一期翻修的绝对禁忌证。

Objective To discuss the therapeutic method of the chronical septic hip replacements with discharging sinuses. Methods Ten cases of infected hip replacement with discharging sinuses, including 6 males and 4 females with a mean age of 59 years old (from 48 to 65 years old ) were reported. The preoper ative mean Harris score was 31 (range 26 to 38), mean erythrocyte sedimentation rate (ESR) was 56 mm/h (38 to 74 mm/h). Cultures and sensitive test before and d uring operation were both carried out. One stage revision was performed in eig ht cases, two stage revision was performed in two cases. Results Preoperation microorganism cultures of joint aspiration or pus in sinus were positive in eigh t cases and negative in two cases; six had staphylococcus and two Gram negative microorganism. Intraoperation microorganism cultures were positive in nine cases and negative in 1 case; seven had staphylococcus and two had Gram negative. Acc ording to the results of preoperation microorganism cultures, six cases of staph ylococcus infection two negative cases of microorganism culture were treated wit h one stage revision, the other two cases of infection by Gram negative microo rganism had undergone two stage revision. No recurrence was found after 19 mon ths (8 to 30 months) follow up. ESR after operation decreased to normal range. Mean Harris score increased significantly to 82.5 (78 to 89) after revision(t- test, P< 0.02). Conclusion For replacements of chronic septic hips with dischar ging sinuses, it is still possible to have satisfactory clinical outcome by one stage revision. The discharging sinuses might not be definitive contraindicat ions for one stage revision for failure cases of hip replacements due to chron ic infection. [