二期翻修术治疗髋关节假体周围感染

Two-staged revision for hip periprosthetic infection

[目的]探讨采用临时间隔物并二期髋关节翻修手术治疗髋关节假体周围感染的有效性和治疗效果。[方法]回顾性分析2010年1月~2014年3月进行二期髋关节翻修手术治疗髋关节假体周围感染的29例患者资料。其中男18例,女11例,平均年龄(58.48±12.26)岁。采用一期取出假体、清创的抗生素间隔物置入,二期行关节翻修置换术。分析患者感染病原,通过比较术前术后Harris评分评估翻修术的效果。[结果]2例细菌培养为耐甲氧西林金黄色葡萄球菌(MRSA)的患者经数次清创后仍不能控制感染,另1例患者二期翻修因感染复发失败。其余26例患者二期手术后平均随访(29.12±9.26)个月(12~51个月),没有发生假体松动和感染复发,术前Harris评分平均为(48.11±19.42)分(18~91分),末次随访时平均为(84.27±14.11)分(58~100分),差异具有统计学意义(P<0.05)。[结论]髋关节假体周围感染通过一期清创,间隔物置入及二期翻修手术可以有效控制感染并重建髋关节功能。而MRSA造成的髋关节假体周围感染是一期清创失败的原因之一。

[Objective] To evaluate the effectiveness and result of provisional spacer combined two-staged total hip arthroplasty for hip periprosthetic infection.[Methods] A retrospective study was done on 29 patients who received two-staged revision for hip periprosthetic infection from January 2010 to March 2014.Of them,18 males and 11 females aged（58.48±12.26）years on average.The patients had the infectious hip revised with remove of all the prostheses,a thorough debridement and antibiotic provisional spacer implanting in the first stage,and revised total hip arthroplasty in the second stage.The reasons of periprosthetic infection were analyzed and the consequences of revision evaluated by comparison of preoperative and postoperative Harris scores.[Results] Of the 29 patients,2 patients proved the Methicillin-Resistant Staphylococcus Aureus（MRSA） infection,had repeated recurrence of infection despite of multiple debridements.Another one failed in the two-staged arthroplasty due to the recurrence of infection.The remaining 26 patients who got successful revised surgeries were followed up for 12 to 51 months with an average of（29.12±9.26） months.No prosthetic loosening and recurred infection happened in anyone of them.The Harris scores significantly improved from（48.11±19.42） on average（ranged 18 to 91） preoperatively to（84.27±14.11）（ranged 58 to 100） at the latest follow up,with a statistical difference between the two time points（P0.05）.[Conclusion] This two-staged revision,including debridement and spacer implanting in the first stage,and revised arthroplasty in the second stage,does achieve satisfactory outcome in term of control of periprosthetic infection and restoration of hip function.The MRSA infection is one of important failure reason of debridement in the first stage.