髋关节置换术后假体周围感染的治疗

目的 探讨髋关节置换术后假体周围感染患者接受清创术、一期翻修术、二期翻修术及旷置术的临床效果.方法 1993年6月至2008年6月因髋关节置换术后假体周围感染接受手术治疗患者46例,男27例,女19例;年龄34～80岁,平均55.8岁.术前诊断感染的方法包括红细胞沉降率、C反应蛋白检查,放射性核素扫描,窦道分泌物及关节穿刺液培养.行保留假体的清创术7例,一期翻修术14例,二期翻修术21例,旷置术4例.术后观察伤口外观,随访时采用Harris评分对髋关节功能进行评估,行实验室检查确定感染控制情况.结果 46例假体周围感染患者中29例培养结果 阳性,表皮葡萄球菌占感染病原体的首位(37.9%),其次为金黄色葡萄球菌(24.2%).35例获得随访,随访时间12～179个月,平均61.6个月.末次随访时Harris评分2～99分,平均76.5分.清创术后假体周围感染的控制率为16.7%,一期翻修术为54.5%,二期翻修术为93.3%,旷置术为100%.二期翻修术后假体周围骨折发生率13.3%,术后脱位率13.3%.11例感染复发,复发时间为感染治疗术后2～127个月,平均39.5个月.其中10例再次接受手术治疗,包括清创术1例、二期翻修术8例、旷置术1例.结论 清创术与一期翻修术的选择应严格把握适应证.二期翻修术感染控制率高,但有发生假体周围骨折和脱位的风险.表皮葡萄球菌及金黄色葡萄球菌足关节感染的主要病原菌.

Treatment of infected total hip arthroplasty

Objective To evaluate the clinical outcome of debridement with Prosthesis retention, one-stage, two-stage revision, and resection arthroplasty for the infected hip replacement. Methods Forty-six patients admitted for infected total hip arthroplasty from June 1993 to June 2008 were reviewed. There were 27 males and 19 females, with an average age of 55.8 years. Preoperative investigations for infection included ESR, CRP, ECT and joint fluid culture from sinus or aspiration. Patients were treated with debride-ment with prosthesis retention, one-stage revision, two-stage revision, or resection arthroplasty to eradicate the infection. For infection evaluation, wound healing, Harris score, and laboratory tests were collected. Re-suits There was evidence of deep infection in infected hip prostheses in 29 patients whose joint fluid cul-ture revealed Staphylococcus epidermidis (37.9%) remained in the first place, following by Staphylococcus aureus (24.2%). The mean duration of follow-up was 61.6 months (range 12 to 179 months). The Harris score at final follow-up was 76.5 (range 2 to 99). Eleven patients suffered a relapse occurred at a mean time of 39.5 months (2 to 127 months) when primary infections were diagnosed. The infection control rates of debridement with prosthesis retention, one-stage revision and two-stage revision were 16.7%, 54.5% and 93.3% respectively. The rate of peri-prosthetie fracture and dislocation were equally 13.3% after two-stage revision arthroplasty. No recurrent infection occurred after resection arthroplasties were performaneed. Con-clusion Debridement with prosthesis retention and one-stage revision can he successful in appropriately se-lected patients. Two-stage revision of an infected hip arthroplasty can achieve a high success rate with the risk of peri-prosthetie fracture and dislocation. Staphylococcus epidermidis and Staphylococcus aureus are the causative agents of the infected hip arthroplasty.