髋关节置换术后慢性感染的手术治疗

目的：探讨髋关节置换术后慢性感染松动的治疗方法。方法：本组12例髋关节置换术后慢性感染松动患者,男7例,女5例,平均年龄58岁（45－65岁）。术前Harris评分平均为30分（24－38分）,血沉平均为55mm/hr(35-74mm/hr)。所有病例术前、术中均进行细菌培养及药敏试验。8例行一期翻修手术,4例行二期翻修手术。结果：10例术中标本细菌培养阳性,2例阴性,主要为表皮葡萄球菌生长。术后平均随访18个月（6－30个月）,感染均未再复发。术后血沉均恢复正常,Harris评分平均82分（78－89分）,较术前提高50分（t检验,P＜0．02）。结论：全髋关节置换术后慢性感染松动的治疗是选择I期翻修或Ⅱ期翻修术,取决于感染程度和致病菌的类型、药物敏感试验的结果以及患者的全身情况,局部软组织和骨质条件。

The Operative Treatment on Chronically Infected Hip Replacement

Objective:To discuss the therapy method of the chronic infection after hip replacement. Method:Twelve operative treated cases of infected hip replacement,including 7 men and 5 women with an mean age of 58 years(45 to 65),were reported.Preoperative mean Harris score was 30 (range 24 to 38),mean erythrocyte sedimentary rate(ESR)was 55 mm/hr(35 to 74 mm/hr).Preoperative and intraoperative microorganism culture and sensitive test were both carried out. Eight of one stage revsion were performed for septic failure of hip replacement, and four of two stage procedures were performed.Results:There were 10 positive of microorganism culture in the operation which were mainly staphylococcus epidermidis,but 2 negative cases. No recurrence was found after 18 months(6 to 30 months)follow up,ESR after operation decreased to normal range.Mean Harris score increased significantly to 82(78 to 89)after revision( t test,P<0.02 ).Conclusion:Whether one stage revision or two stage procedures are performed for treating the chronic infection after hip replacement is depended on severity of sepsis and type of bacteria,general conditions of patients,local conditions of soft tissue and bone stock.