人工髋关节置换术后急性血源性假体周围感染患者保留假体的清创治疗

Treatment of acute hematogenous periprosthetic joint infection following total hip arthroplasty with debridement and prosthesis retention

目的探讨在人工髋关节置换术后急性血源性假体周围感染的治疗中,应用保留假体清创术的临床疗效。方法回顾性研究2002年1月至2014年9月,我院应用保留假体清创术结合抗生素治疗14例髋关节置换术后急性血源性假体周围感染患者。其中11例存在与关节腔相通的窦道。所有患者入院后常规检查血沉、C反应蛋白,术前或术中取关节液和关节周围软组织行细菌培养。术中髋关节脱位后,彻底清理关节周围炎性组织,术后所有患者均足量应用抗生素。平均随访66.2个月。结果 3例关节液及组织的细菌培养阴性,11例细菌培养阳性,其中3例培养出2种或3种病原菌。金黄色葡萄球菌3例,大肠埃希菌1例,表皮葡萄球菌1例,星座链球菌1例,白色念珠菌1例,肺炎克雷伯杆菌1例,1例培养出大肠埃希菌和无乳链球菌,1例为大肠埃希菌、铜绿假单胞菌和粪肠球菌,1例为凝固酶阴性葡萄球菌和洋葱伯克霍尔德菌。抗生素平均使用为75.2天。平均随访66.2个月,至末次随访时,8例感染得到控制,治疗成功率为57.1%,Harris评分为56~98分,结论保留假体清创结合足量抗生素治疗人工髋关节置换术后急性血源性假体周围感染有一定的效果。准确诊断,严格选择患者,在症状出现早期及时进行清创,可以部分达到保留假体控制感染之目的。

Objective To investigate the effectiveness of antibiotics combined with debridement for acute hematogenous periprosthetic joint infection （ PJI ） with retention of hip implant. Methods We retrospectively collected data from 14 cases of acute hematogenous periprosthetic joint infection following total hip arthroplasty （ THA ）, which were managed with debridement, antibiotics and implant retention （ DAIR ） procedure from January 2002 to September 2014. Before the debridemcnt surgery, erythrocyte sedimentation rate （ ESR ）, C-reactive protein （ CRP ） and synovial fluid culture were routinely measured. Adequate antibiotics therapy was applied postoperatively. The outcome of DAIR treatment was evaluated after a minimal follow-up of 2 years. Results Eleven of 14 cases showed definite microorganisms with more than 2 samples including 3 strains of Staphylococcus aureus, 1 enterococcus, 1 Staphylococcus epidermidis, 1 Streptococcus constellatus, 1 Candida albicans, 1 Klebsiella pneumoniae and 3 cases of polymicrobial infection, the rest were culture-negative. At a mean follow-up of 66.2 months, there were 8 cases that retained the prosthesis without further evidence of infection. The success rate was 57.1%. Conclusions Debridement, antibiotic treatment and implant retention has good therapeutic effects in the treatment of acute hematogenous periprosthetic joint infection following THA.