人工全髋关节置换术治疗髋关节感染后遗关节畸形的疗效研究

Effectiveness of total hip arthroplasty for hip infection sequelae

目的探讨人工全髋关节置换术(total hip arthroplasty,THA)治疗髋关节感染后遗关节畸形患者,其髋关节功能恢复及感染再发的情况。方法回顾2010年6月—2017年5月采用THA治疗的31例(31髋)髋关节感染后遗关节畸形患者临床资料。男18例,女13例;年龄20～71岁,平均46.1岁。化脓性感染17例,结核性感染9例,感染性质不详5例;感染至治愈时间6～25个月,平均13.9个月。明确感染源患者感染治愈至THA时间为6～58年,平均23.4年。根据Kim分型标准:Ⅰ型12例,Ⅱ型9例,Ⅲ型10例。关节发育异常后遗骨关节炎21例,病理性脱位7例,髋关节强直3例。患侧下肢短缩0.5～5.6 cm,平均2.9 cm。术后通过体征及实验室检查评估感染情况,摄髋关节X线片评估髋关节骨性结构、是否有感染性病灶及测量下肢长度,Harris评分评估髋关节功能。结果患者均获随访,随访时间10～63个月,平均34个月。术中留取组织细菌培养结果均为阴性。术后切口均Ⅰ期愈合;术后1例发生坐骨神经刺激症状,1例关节后脱位。随访期间均无感染再发。末次随访时,髋关节功能参照Harris评分获优8例、良19例、中4例,优良率达87%。X线片复查示无斑片状骨密度降低及点状硬化,无透亮区。与健侧相比,5例患侧肢体短缩,长度为0.4～1.3 cm,平均0.6 cm;患者均未见明显跛行,无肢体不等长主观感觉。结论髋关节感染后遗关节畸形患者经评估确定为感染静止期后行THA,可以获得良好的髋关节功能,感染再发风险低。

Objective To evaluate hip function and reinfection of the patients with hip infection sequelae aftertotal hip arthroplasty (THA) treatment. Methods A clinical data of 31 patients (31 hips) with hip infection sequelae, whowere treated with THA between June 2010 and May 2017, was retrospectively analyzed. There were 18 males and 13females, with an average age of 46.1 years (range, 20-71 years). There were pyogenic infection in 17 cases, tuberculousinfection in 9 cases, and unknown source of infection in 5 cases. The average time from infection to cure was 13.9 months(range, 6-25 months). The average time from cure to operation was 23.4 years (range, 6-58 years) for patients withconfirmed source of infection. According to Kim classification, 12 cases were rated as typeⅠ, 9 as typeⅡ, and 10 as typeⅢ. There were 21 cases of osteoarthritis after dysplasia, 7 cases of pathologic dislocation, and 3 cases of hip ankylosis.After operation, the infection was assessed by physical signs and laboratory tests; X-ray film of the hip was taken to assessthe skeletal structure of the hip and infectious lesion; the length of the lower limb was measured, and the function of thehip joint was evaluated by Harris score. Results All patients were followed up 10-63 months (mean, 34 months). The result of bacterial culture was negative. The incisions healed by first intention. The sciatic nerve stimulation occurred in1 case and posterior dislocation of the joint occurred in 1 case after operation. There was no recurrence of infection and noaseptic loosening of the prosthesis. According to Harris score, the function of the hip was rated as excellent in 8 cases,good in 19 cases, and fair in 4 cases at last follow-up; and the excellent and good rate of hip joint function was 87%. X-rayfilms showed no patchy bone density reduction, spot hardening, or light areas. The length of affected limb was not fullyequal with the unaffected limb in 5 cases, and the difference between two sides ranged from 0.4 to 1.3 cm (mean, 0.6 cm).At last follow-up, all patients had no obvious claudication or sensation of unequal length. Conclusion THA can obtainsatisfactory hip function and has low risk of infection recurrence for the patients with hip infection sequelae, who wereassessed as the hip infection in a dormant state.