老年患者人工髋关节置换术后感染的治疗对策

A treatment strategy of infection after artificial hip joint replacement surgery of senile patients

目的:回顾性分析及文献评阅老年患者人工髋关节置换后假体周围感染的原因,为临床提供有效的诊治方案。方法:选取20例人工髋关节置换术后假体周围感染患者临床资料进行回顾性分析,探讨其人工髋关节置换术后假体周围感染的临床特点、治疗方法及预后,并进行文献复习。结果:对所有患者进行6~36个月随访,平均随访19.4个月,20例患者发生人工髋关节置换后感染的病原菌为金黄色葡萄球菌6例,表皮葡萄球菌5例,凝固酶阴性葡萄球菌4例,铜绿假单胞菌3例,阴沟肠杆菌1例,溶血性链球菌1例。治疗根据药敏选用敏感抗生素,行关节I期或Ⅱ期翻修,并行翻修后随访,最终18例临床治愈,2例死亡。结论:明确人工髋关节置换后假体周围感染的病原菌非常重要,适当的外科治疗和抗生素治疗可以达到良好的临床效果。

Objective： To research the causes of periphery infection of prosthesis after artificial hip joint replacement surgery of senile patients by using retrospective analysis and literature review so as to provide effective scheme of diagnosis and treatment for clinical practice. Methods： The clinical data of 20 patients with periphery infection of prosthesis after artificial hip replacement surgery were reviewed, and the clinical features, treatment and prognosis of periphery infection of prosthesis after artificial hip replacement were discussed, and the relative literature was reviewed. Results： The follow-up time of all patients were 6～36 months, and the average follow-up time of them was 19.4 months. In 20 patients, the pathogens of 6 cases were Staphylococcus aureus, and the pathogens of 5 cases were Staphylococcus epidermidis, and the pathogens of 4 cases were coagulase negative Staphylococcus, and pathogens of 3 cases were Pseudomonas aeruginosa. Besides, pathogens of 1 case was Enterobacter cloacae, and pathogens in 1 case was Streptococcus hemolyticus. On the other hand, in treatment, antibiotics were selected according to drug sensitivity, and rebuilding of joint of Ⅰ stage or Ⅱ stage was implemented, and then followed up post rebuilding was carried out. Finally, there were 18 patients achieved situation of clinical cure and 2 patients died. Conclusion： It is very important to make clear the pathogens of periphery infection of prosthesis after artificial hip joint replacement surgery. And appropriate surgical treatment and antibiotic treatment can achieve good clinical results.