二期翻修手术在髋关节置换术后晚期慢性假体周围感染治疗中的应用

Two-stage revision of late chronic periprosthetic hip joint infections

目的探讨二期翻修手术治疗髋关节置换术后晚期慢性假体周围感染(PJI)的中、短期临床疗效。方法回顾性研究。纳入2011年1月—2017年1月空军军医大学西京医院骨科收治的髋关节置换术后出现晚期慢性PJI的27例(27髋),其中男7例、女20例,年龄52~77(63.9±5.5)岁,均由同一主刀医生采用二期翻修手术的方法治疗。术后定期复查X线和红细胞沉降率(ESR)、C-反应蛋白(CRP),以评价假体稳定性和感染控制情况,结合患肢手术前后Harris评分、疼痛视觉模拟评分(VAS)以及SF-12生理、心理评分评价临床疗效。结果本组27例术后随访2.0~7.8(4.0±1.5)年。随访期间复查X线未见假体松动及骨溶解征象,假体稳定性良好;末次随访时患者均无感染征象,ESR和CRP均在正常范围,感染控制率100%,无一例感染复发。与术前相比,末次随访时VAS评分由(6.0±1.1)分减轻至(0.4±0.5)分,Harris评分由(28.9±9.1)分提高至(80.4±11.3)分,SF-12生理评分由(23.0±2.8)分提升至(39.3±7.3)分、心理评分由(33.8±5.7)分提升至(51.7±10.3)分,差异均有统计学意义(t=2.580、28.650、10.683、11.656,P值均<0.05),显示中、短期临床疗效满意。结论采用二期翻修手术治疗晚期慢性PJI安全、有效,术后中、短期感染控制率及假体稳定性高,关节功能良好。

Objective To explore the short-term and medium-term result of two-stage revision surgery in the treatment of late chronic periprosthetic joint infection(PJI)after hip replacement.Methods The retrospective study was conducted.Between January 2011 and January 2017,27 patients(27 hips)of late chronic PJI after hip replacement in the Department of Orthopaedics,Xijing Hospital of Air Force Medical University were included.Among them,there were 7 males and 20 females.The age ranged from 52 to 77(63.9±5.5).One surgeon performed all surgeries in the study.At the clinical status analysis,radiographic evaluation,erythrocyte sedimentation rate(ESR)and C-reactive protein(CRP)were performed regularly to evaluate the stability of the prosthesis and to judge whether the infection was controlled.Harris score,Visual Analogue Score(VAS)and SF-12 score before and after operation were noted to evaluate the clinical efficacy.Results The present study included 27 patients.The follow-up time ranged from 2 to 7.8(4.0±1.5)years.During the follow-up,no signs of prosthesis loosening and osteolysis were found on X-ray.No local or systemic infection symptoms were found.The results of ESR and CRP were in the normal range.The infection control rate was 100%.No infection recurred.Compared with preoperative values,the mean VAS was reduced from 6.0±1.1 to 0.4±0.5.The mean Harris hip score was improved from 28.9±9.1 points to 80.4±11.3 points.The mean physical component summary and mental component summary score in SF-12 was improved from 23.0±2.8,33.8±5.7 points to 39.3±7.3 and 51.7±10.3 points.The difference was statistically significant(t=2.580,28.650,10.683,11.656,all P values<0.05)which proved that the short-term and medium-term clinical efficacy of this study was satisfactory.Conclusions Two-stage revision of the late chronic PJI is a safe and reliable procedure with high rates of infection control,prosthesis stability and satisfactory joint function in the short and medium-term follow-up.