分体式抗生素骨水泥占位器在治疗人工全髋关节感染中的应用

Application of articulating antibiotic cement spacer in the treatment of periprosthetic joint infection after total hip arthroplasty

目的研究分体式抗生素骨水泥占位器在治疗人工全髋关节置换(THA)术后感染中的应用。方法根据纳入和排除标准,共纳入21例THA术后关节假体周围感染的患者,根据使用的占位器不同,分为试验组11例(分体式占位器)和对照组10例(单体式占位器),记录每组患者的一般资料、手术时间、术中出血量、术后引流量、住院天数,疼痛视觉模拟评分(VAS)、髋关节Harris评分(HHS)和欧洲生活质量评分(EQ-5D)等,比较两组间的差异。结果两组患者均无占位器脱位,断裂等并发症发生。试验组旷置手术时间为(132.09±16.02)min,长于对照组[(109.90±16.34)min,t=2.886,P=0.009]。试验组翻修手术前HHS评分为(82.67±7.30)分,高于对照组[(67.80±10.43)分,t=3.806,P=0.001];试验组翻修手术前EQ-5D评分为(0.74±0.22)分,高于对照组[(0.50±0.11)分,t=3.070,P=0.006]。试验组翻修手术中出血量为(407.27±116.02)mL,少于对照组[(617.00±208.38)mL,t=2.811,P=0.014]。但两组的VAS评分没有明显差异(P>0.05)。结论采用分体式占位器,可以明显改善患者感染治疗期髋关节功能,提高患者满意度,临床应用价值更高。

Objective To investigate the clinical efficacy of articulating antibiotic cement spacer in the treatment of periprosthetic joint infection after total hip arthroplasty.Methods According to the inclusion and exclusion criteria,a total of 21 patients with periarticular infection after total hip arthroplasty(THA)were analyzed.According to the type of spacers used during the revision surgery,they were divided into the experimental group,in which an articulating spacer was adopted in 11 cases,and the control group,in which a non-articulating spacer was used in 10 cases.Demographic information,operation duration,intraoperative blood loss,postoperative drainage,length of hospital stay,Visual Analogue Scale(VAS),Hip Harris scores(HHS)and EuroQol Five Dimensions Questionnaire(EQ-5D)of both groups were collected and compared.Results None cases of spacer breakage or dislocation were found in both groups.The surgical duration of spacer implantation in the experimental group was(132.09±16.02)min,longer than that in the control group(109.90±16.34)min(t=2.886,P=0.009).The HHS scores of the experimental group before revision were(82.67±7.30),higher than that of the control group(67.80±10.43)(t=3.806,P=0.001).The preoperative EQ-5D scores of the experimental group were(0.74±0.22),higher than that of the control group(0.50±0.11)(t=3.070,P=0.006).The blood loss during revision surgery in the experimental group was(407.27±116.02)mL,less than that in the control group[(617.00±208.38)mL,t=2.811,P=0.014].But there was no significant difference in VAS scores between the two groups(P>0.05).Conclusion Articulating cement spacer can significantly improve the hip joint function,improve patient satisfaction and thus should be advocated.