髋膝关节慢性化脓性关节炎二期手术疗效分析

Analysis of Prognostic Results of Two-Stage Surgical Treatment for Chronic Septic Arthritis of Hip And Knee

目的探讨采用临时间隔物并二期手术治疗髋、膝关节慢性化脓性关节炎的疗效。方法回顾性分析北京积水潭医院2017年1月至2019年12月期间诊断为髋关节或者膝关节化脓性关节炎并接受二期手术流程的22例病例资料,男12例,女10例;年龄34~74岁,平均(57.4±10.5)岁。其中髋关节化脓性关节炎患者7例,膝关节化脓性关节炎患者15例。采用Kaplan-Meier生存分析法计算患者的感染治疗成功率。比较手术前后髋关节患者Harris髋关节评分(Harris hip score,HHS)与膝关节患者美国特种外科医院(hospital for special surgery,HSS)膝关节评分,分析采用该方法的治疗效果。结果1例膝关节患者在接受手术后10个月因内科疾病死亡;1例髋关节患者在术后9个月感染复发。5例患者仅接受一期手术治疗,但随访中未出现感染复发。17例患者完成二期手术,其中15例患者达到临床治愈。治疗成功率在2年时为89.5%(95%CI:64.1%~97.3%)。髋关节组患者HHS评分及膝关节组患者HSS评分均较术前明显提高。结果采用临时间隔物并二期手术是治疗慢性髋、膝关节化脓性关节炎的有效方法,可以获得较高的感染控制率,同时可以有效地重建关节功能。

Objective To investigate the efficacy and clinical effect of two-stage treatment protocol with temporary spacer for chronic septic arthritis of hip and knee.Methods From January 2017 to December 2019,22 patients diagnosed of septic arthritis of hip or knee joint underwent two-stage protocol in Beijing Jishuitan Hospital were analyzed retrospectively.12 male and 10 female patients were enrolled in this study with a mean age of(57.4±10.5)years old(range:34~74 years).Among these patients,there were 7 patients with hip chronic septic arthritis and 12 patients with knee chronic septic arthritis.The success rate of infection treatment was calculated by Kaplan-Meier survival analysis.The therapeutic effect was reported by comparison with preoperative and postoperative Harris hip score(HHS)of hip patients,and hospital for special surgery(HSS)knee scoreof knee patients.Results One knee patient died of medical disease 10 months after operation.One hip patient had recurrence of infection 9 months after operation.Five patients received only the first stage of the protocol,but there was no evidence of infection recurrence during follow-up.17 patients completed the protocol while 15 patients achieved success.The treatment success rate was 89.5%(95%confidence interval:64.1%~97.3%)at two years.HHS score in hip group and HSS score in knee group were significantly higher than those before operation.Conclusion Two-stage operation with temporary spacer is an effective treatment for chronic septic arthritis of hip and knee,with both high infection control rate and considerable joint function restore.