临时关节型抗生素骨水泥占位器治疗人工髋关节置换术后感染30例临床分析

Temporary joint type antibiotic-impregnated cement spacer in the treatment of infection after total hip arthroplasty in 30 cases

目的探讨临时关节型抗生素骨水泥占位器在人工髋关节置换术后感染治疗中的临床效果。方法人工髋关节置换术后发生感染患者30例(30髋),随机分为对照组和观察组各15例,对照组应用灌注冲洗型占位器治疗,观察组应用抗生素骨水泥占位器治疗。比较2组占位器植入手术时间、术中出血量、术后卧床时间、住院时间;分别于下床第1天及二期翻修术前1d评定2组美国特种外科医院膝关节功能评分(hospital for special surgery knee score,HSS),测定髋关节活动度;比较2组治疗满意度。结果观察组占位器植入手术时间[(2.50±0.30)h]、术后卧床时间[(6.20±0.72)d]及住院时间[(25.83±3.20)d]较对照组[(3.31±0.28)h、(45.29±5.10)d、(53.15±4.92)d]短,术中出血量[(1 215.18±121.86)mL]较对照组[(2 122.87±204.28)mL]少(P<0.05);观察组下床第1天HSS评分[(56.92±5.17)分]、关节活动度[(49.75±4.21)°]与对照组[(56.03±5.39)分、(42.91±4.13)°]比较差异无统计学意义(P>0.05);二期翻修术前1d,观察组HSS评分[(87.82±7.89)分]高于对照组[(79.31±8.04)分](P<0.05),关节活动度[(67.23±4.91)°]与对照组[(57.31±4.74)°]比较差异无统计学意义(P>0.05);观察组治疗总体满意率(93.3%)高于对照组(80.0%)(P<0.05),术后感染复发率(0)低于对照组(20.0%)(P<0.05)。结论临时关节型抗生素骨水泥占位器治疗人工髋关节置换术后感染可缩短占位器植入手术时间、术后卧床及住院时间,减少术中出血量,且与周围组织融合好,对关节功能影响小,患者满意度高。

Objective To investigate the clinical effect of temporary joint type antibiotic-impregnated cement spacer on infection after total hip arthroplasty.Methods Thirty patients with infection after hip arthroplasty（30hips）were randomly divided into observation group and control group,with 15 patients in each group.Control group was treated with perfusion spacer and observation group was treated with antibiotic-impregnated cement spacer.The operation lasting time,intraoperative blood loss volume,postoperative bed time and hospitalization stay were compared between two groups.The hospital for special surgery knee score（HSS）was assessed on the first day after getting out of bed and the day before two-stage revision arthroplasty,and the range of motion was determined.The treatment satisfaction was compared between two groups.Results The operation lasting time（（2.50±0.30）h）,postoperative bed time（（6.20±0.72）d）and hospitalization stay（（25.83±3.20）d）in observation group were significantly shorter than those in control group（（3.31±0.28）h,（45.29±5.10）d,（53.15±4.92）d）,and blood loss volume in observation group（（1 215.18±121.86）mL）was significantly less than that in control group（（2 122.87±204.28）mL）（P〈0.05）.There were no significant differences in the HSS score（（56.92±5.17）min）vs（56.03±5.39）and range of motion（（49.75±4.21）°vs（42.91± 4.13）°）between observation group and control group on the first day after getting out of bed（P〉0.05）.On the first day before two-stage revision arthroplasty,the HSS score was significantly higher in observation group（87.82 ±7.89）than that in control group（79.31±8.04）（P〈0.05）,and there was no significant difference in the range of motion between observation group（（67.23±4.91）°）and control group（（57.31±4.74）°）（P〉0.05）.The patients＇satisfaction rate was significantly higher and postoperative infection recurrence rate was significantly lower in observation group（93.3%,0）than those in control group（80.0%,20.0%）（P〈0.05）.Conclusion Temporary joint type of antibiotic-impregnated cement spacer can shorten the operation lasting time,postoperative bed time and hospitalization stay after artificial hip replacement,reduce the intraoperative blood loss volume,and integrate well with surrounding tissues,with little influence on joint function and high patient satisfaction.