人工髋关节置换术后慢性感染的手术治疗

Operation on chronic infection after femoral head replacement

目的 :探讨人工髋关节置换术后慢性感染的治疗方法。方法 :6例人工髋关节置换术后慢性感染患者 ,术前Harris评分平均 34分(2 8～ 39分 ) ,血沉平均 51mm/h(35～ 72mm/h)。所有病例术前、术中均进行细菌培养及药敏试验。 6例患者均行一期全髋翻修术。结果 :术前细菌培养 2例阴性 ,4例阳性 ,均为表皮葡萄球菌。术中细菌培养 5例阳性 ,均为表皮葡萄球菌。术后平均随访 1 7个月 (7～ 2 6个月 ) ,均未再复发。术后血沉均恢复正常 ,Harris评分平均 83 5分 (76～ 88分 ) ,较术前平均提高 50分 (配对t检验 ,P <0 0 2 )。结论 :人工髋关节置换术后慢性感染者 ,一期翻修可以取得满意的临床疗效。慢性感染不应该作为一期翻修的绝对禁忌证。

Objective:To discuss the therapeutic method of the chronic infection after hip replacements.Methods:Six cases infected by hip replacement.The preoperative mean Harris score was 34(range 28 to 39),mean erythrocyte sedimentation rate(ESR)was 51 mm/h (35 to 72 mm/h).Both test of cultures and sensitive were carried out for all patients.Preoperative and postoperative One-stage revision was performed in six cases.Results:Preoperation microorganism cultures were positive in two cases and negativein in four cases,all was staphylococcus epidermidis.Intraoperation microorganism cultures were positive in five cases,all was staphylococcus epidermidis.No recurrence was found after operation 17 months(7 to 26 months)follow-up.ESR were normal after operation.Mean Harris score was 83.5(76 to 88),increasing 50 than preoperative(t-test,P<0.02).Conclusions:For replacements of chronic septic hips,it is possible to have satisfactory on clinical outcome by one-stage revision.Chronic infection might not be definitive contraindications on one-stage revision.