骨水泥间隔物在人工髋关节置换术后感染翻修术中的应用

目的 探讨骨水泥间隔物在人工髋关节置换术后感染中的应用方法 及作用.方法 1999年1月至2007年12月收治单侧人工髋关节置换术后感染者36例,男20例,女16例;假体取出时年龄34～80岁,平均52岁.置换术后至出现感染的时间为2周～19年.34例在一期手术中取出全部假体,2例分次取出假体.骨水泥间隔物内加入5%～10%的万古霉素.对有脓性分泌物者留置出入管进行灌洗,一般维持3～7 d,术后1周可下地活动,但患肢至少免负重2个月.术后常规静脉使用万古霉素,或根据细菌培养结果 选用敏感抗生素,2周后改敏感抗生素或口服利福平巩固4～8周.结果 34例患者的感染在术后3～19个月内得到有效控制;其中2例间隔物折断(支架为髓内钉),1例间隔物脱位;2例患者(以斯氏针和原股骨假体为支架者各1例)在感染控制后拒绝翻修.2例感染持续存在,1例行间隔物取出、股骨上端旷置,术后感染获得控制;1例行间隔物取出、股骨上端旷置,术后因并发症死亡.使用间隔物后的感染治愈率为94.7%.结论 骨水泥间隔物可通过局部缓慢释放高浓度抗生素明显提高感染的治愈率,同时可维持关节的稳定性,限制瘢痕形成,避免下肢不等长,便于再次进行关节置换.

The application of bone cement spacer on the treatment of infections following artificial hip replace-ment

Objective To study the application and effects of bone cement spacer on the treatment of infections following artificial hip replacement. Methods Among the 36 eases of infections following uni-lateral hip replacement, 20 patients were males and 16 were females. The average age of prosthesis removing was 52 years. The time interval between the hip replacement and the infection varied form 2 weeks to 19 years. 34 eases took out the total hip prosthesis in the first-stage procedure; 1 case took out the acetabular 5 month later due to re-infection; 1 case took out the total hip prosthesis 1 month later due to re-infection. The spacers were made from bone cement mixed by 5％-10％ vancomycin, implanted the femoral medullary cav-ity. Lavage the indwelling tubes if there were more purulent secretions. Patients were given routine intra-venous vancomyein, twice a day, or sensitive antibiotics according to the bacterial culture Results . Two weeks later, the medication was changed to other sensitive antibiotics or oral Rifampin for 4 to 8 weeks. The lavage was generally maintained for 3 to 7 days. The patients were allowed to walk unbearing 1 week postoperation, unbearing at least 2 months. Results Infections in 34 patients were effectively controlled after 3 to 19 months respectively. Among them, 2 presented spacer fracture (the stent was the intramedullary pin); 1 showed spacer dislocation; 2 patients (a Steinmann pin and a original femoral prosthesis as the stents for each) rejected revision; 2 patients had continued infections, received spacer removal and Girdstone opera-tion, and then 1 infection was effectively controlled, the other died due to complication. The successful rate was 94.7％. Conclusion Bone cement spacers are able to raise the successful rate to control the infection through slow local release of high-concentration antibiotics significantly and are helpful to maintain joint sta-bility, restrict the formation of scars, avoid lower limb length inequality, reimplant the prosthesis easily.