抗生素骨水泥股骨头临时假体治疗髋关节置换术后感染

目的总结评估Ⅰ期清创后采用自制抗生素骨水泥股骨头假体控制感染,Ⅱ期翻修重建治疗人工髋关节置换术后感染的临床效果。方法自2006年1月至2010年11月共收治11例（12髋）髋关节置换术后感染患者,均采用Ⅱ期翻修。其中男7例8髋,女4例4髋。年龄29～80岁,平均60岁,术前Harris评分17～45分,平均（32±7.63）分。所有患者采用Ⅰ期取出假体,彻底清创,置入自制抗生素骨水泥股骨头假体,间隔4～20个月（平均12个月）,待血沉、C反应蛋白、血白细胞计数正常,伤口局部无感染表现后,行Ⅱ期翻修重建。结果本组患者切口均I期愈合,无伤口并发症发生。所有患者均获得随访,随访时间6～40个月,平均20个月。所有病例在随访时感染均没有复发,感染控制率100%。。患者髋关节疼痛和关节功能均有明显改善。随访时Harris评分65～96分,平均（87±7.72）分,与术前比较有统计学差异（t=38.81,P〈0.01）。结论Ⅰ期清创后用抗生素骨水泥股骨头假体可有效控制髋关节置换术后感染,减少肢体短缩;Ⅱ期翻修重建手术可根据患者的情况选择骨水泥或非骨水泥假体,均可取得良好的临床疗效。

Antibiotic-loaded cement femoral prosthesis in treatment of hip arthroplasty infection

Objective To evaluate the effectiveness of antibiotic-loaded cement femoral prosthesis implantation after primary debridement and two-stage hip prosthesis revision in the treatment of hip arthroplasty infection. Methods Between January 2006 and November 2010, 11 cases （12 hips） of hip arthroplasty infection were treated by two-stage revision. There were seven men （ eight hips） and four women （four hips） with a mean age of 60 years （range, 29 -80years）. The Harris scores was （32 ± 7. 63 ） （range, 17 -45 ）. All the patients were treated as follows： in the first stage, the infected prosthesis was removed, debfidement was performed, and an antibiotic-loaded cement femoral prosthesis was then implanted for4 to 20 months （average, 12 months）. When the results of C reactive protein, leukocyte count and erythoroeyte sedimentation rate were back to normal and no infective sign was found around the incision, a two-stage revision was performed. All cases were regularly followed up for 4 to 40 months （average, 20 months）. Results All 11 patients achieved healing of incision by first intention, and no complications occurred. No reinfection was found in the follow-up. The function of hip was improved. The Harris score was （ 87± 7. 72 ） （ range, 65 - 96 ） in the follow-up, showing significant improvement compared with preoperative score （ t = 38.81, P 〈 0. 01 ）. Conclusions The implantation of antibiotic- loaded cement femoral prosthesis in the first stage after surgical debridement is effective for treatment of hip arthroplasty infection. The antibiotic-loaded cement femoral prosthesis can also help to reduce shortening deformity in extremities. According to the patients＇ conditions, cement or eementless hip prosthesis may be used in the two-stage hip prosthesis revision to get satisfactory clinical effect.