未使用占位器的二期翻修治疗髋关节置换术后感染

Treatment of infection after hip arthroplasty by spacer-free two-stage revision

目的探讨不使用占位器的二期翻修治疗髋关节置换术后假体周围感染的临床效果。方法从2009年8月至2017年12月期间,对在西安交通大学第二附属医院接受未使用占位器的二期髋关节翻修治疗的21位既往行人工髋关节置换术后感染的患者(其中男性6例,女性15例,年龄28~78岁)进行随访观察。该组患者均采用一期手术取出髋关节假体旷置(未置放占位器),待临床表现及血液中相关炎性指标降至正常时再进行二期翻修,应用配对t检验以及Wilcoxon秩和检验分别评估患者术前术后的髋关节Harris评分及患肢缩短水平。结果 21例患者术后随访(4.0±2.8)年,术后的末次随访时髋关节Harris评分为(86±4)分,与翻修术前的(48±5)相比,有显著性差异(t=25.509,P<0.01),术后患肢短缩为0.1 cm(-0.20,0.35)cm(负值代表患侧肢体较健侧增加的长度),与术前4.3 cm(3.85,4.90)cm相比,有显著性差异(Z=-4.016,P<0.01),术后1例出现再次感染。结论不使用占位器的二期翻修术治疗髋关节假体周围感染具有较高的感染控制率,同时也不会因为髋关节局部软组织挛缩而引起患肢的明显缩短,可以获得良好的术后髋关节功能。

Objective To investigate the clinical effect of peri-prosthetic infection treatment of twostage exchange without the use of the spacers. Methods Twenty-one patients with hip peri-prosthetic infection following hip replacement,who underwent the spacer-free two-stage revision in the Second Affiliated Hospital of Xi’an Jiao Tong University from August 2009 to December 2017,were analyzed. These patients included six males and 15 females,aged from 28 to 76 years. In the first stage,these patients were treated by surgical removal of all components without spacers. When the clinical evaluation and serum inflammatory markers suggested the infection had been resolved,the second stage of debridement and new prosthesis replacement was performed. The effects were evaluated with Harris hip score and limb shortening via paired ttest and Wilcoxon rank sum test. Results All the patients were followed up for（4. 0 ± 2. 8） years on average. The hipHarris score（86. 4 ± 4. 4） at the last follow-up was significantly higher than the score（48. 4 ±4. 9） before two-stage revision（t = 25. 509,P 〈 0. 01）. The preoperative length of the affected limb was 4. 3（3. 85,4. 90） cm shorter than that of the healthy side,while it was 0. 1 cm（-0. 2,0. 35） cm（negative value represented the increased length of the affected side compared with the healthy side） after the two-stage revision,and the difference was significant（Z =-4. 016,P 〈 0. 01）. One patient was infected after the operation. Conclusion Two-stagerevision without spacer has a high infection control rate in the treatment of periprosthetic hip infection,and does not result in significant shortening of the limb due to peripheral tissue contracture of the hip; the patients could get better hip function.