老年患者髋关节置换后感染的治疗策略

Treatment strategies for infection after hip arthroplasty in the elderly patients

背景:虽然髋关节置换已经成为成功的外科手术之一,但髋关节置换后感染仍然是严重的并发症。目的:分析近年来髋关节术后感染的临床特点及治疗效果,为提高髋关节术后感染的诊疗水平提供借鉴。方法:应用计算机检索2006年至2016年CNKI/万方数据库和Pub Med/Medline数据库,使用术语"髋关节置换"和"感染"。分析3家医院2006年1月至2016年1月收治的20例髋关节置换后感染患者的病历资料。结果与结论:(1)分期髋关节翻修仍是治疗髋关节置换后感染的主要方法,抗生素治疗的持续时间仍有争议,比较多考虑的问题是增加细菌耐药性,尤其在髋关节置换后广泛应用万古霉素;(2)分析的3家医院资料显示金黄色葡萄球菌是检出比例最高的菌株,达到30%,其次是表皮葡萄球菌占25%,凝固酶阴性葡萄球菌检出比例也较高,达到20%,葡萄球菌属总体占75%。革兰阴性菌主要以铜绿假单胞菌、阴沟肠杆菌和溶血性链球菌为主;(3)结果提示,髋关节置换后应当根据药敏结果及时调整抗生素。

BACKGROUND:Hip arthroplasty has become mature,but infection after arthroplasty is a serious complication.OBJECTIVE:To analyze the clinical characteristics and treatment outcomes of infection after hip arthroplasty,thus providing reference for improving the diagnosis and treatment of postoperative infection.METHODS:A computer-based online search of CNKI,WanFang,PubMed and Medline databases from 2006 to 2016 was conducted using the keywords of“hip arthroplasty,infection”in English and Chinese,respectively.Clinical data of 20 patients with infection after hip arthroplasty in three hospitals from January 2006 to January 2016 were analyzed retrospectively.RESULTS AND CONCLUSION:(1)Two-stage revision is considered to be the main method for treating infection after hip arthroplasty.The duration of antibiotic therapy remains controversial.The increased bacterial resistance is difficult,especially the widespread use of vancomycin after hip arthroplasty.(2)Staphylococcus aureus is the highest proportion of strains detected,up to 30%,followed by 25%for staphylococcus epidermidis,20%for coagulase-negative staphylococcal and 75%for staphylococcus in the three hospitals.Gram-negative bacteria mainly contain pseudomonas aeruginosa,enterobacter cloacae and hemolytic streptococcus.(3)To conclude,antibiotics should be timely adjusted according to antibiotic susceptibility results after hip arthroplasty.