髋臼骨折术后感染的外科治疗

Surgical treatment of postoperative infection of acetabular fractures

目的探讨髋臼骨折术后感染的外科治疗方法及体会。方法选择16例髋臼骨折术后感染患者为研究对象,根据患者髋臼缺损程度及股骨头坏死情况,4例患者采用单纯关节清创术,12例患者在彻底清创的基础上采用全髋关节置换术。采用Harris评分进行髋关节功能评价。结果术后1例全髋置换术患者感染复发,行二次翻修手术后愈合,其余患者伤口均Ⅰ期愈合,ESR和CRP在术后2～4周下降至正常水平。患者均随访6个月至2年,末次随访时Harris评分为75～90分。全髋关节置换术患者均无假体松动及下沉。结论根据髋臼骨折术后感染患者髋臼缺损程度及股骨头坏死情况,选择清创术或人工全髋关节置换术治疗,可以彻底清除感染病灶,最大限度地挽救患者的髋关节功能。

Objective To explore the surgical treatment methods and experience of postoperative infection of acetabular fracture.Methods Sixteen cases of patients with postoperative infection of acetabular fracture were selected as the study objects.According to the degree of acetabular defect and the femoral head necrosis,4 cases were treated with joint debridement alone,and 12 cases were treated with total hip arthroplasty based on debridement.The hip function was evaluated by the Harris score.Results The infection recurred in 1 case of the patient with total hip arthroplasty,the patient healed after secondary revision surgery,the other patients healed by the first intention.The levels of ESR and CRP decreased to normal at postoperatively 2-4 weeks.All patients were followed up for 6 months to 2 years.At the last followup,the Harris score was 75-90.There were no patients with total hip arthroplasty occurred implants loosening and sinking.Conclusion According to the degree of acetabular defect and the femoral head necrosis in patients with postoperative infection of acetabular fracture,selection of debridement or total hip arthroplasty can completely remove the infection,maximally save hip joint function of patients.