髋关节置换术后感染的手术治疗

目的探讨髋关节置换术后感染手术治疗的临床疗效。方法共11例髋关节置换术后感染患者,男6例,女5例,平均63岁(54～71岁)。术前Harris评分25～40分,平均33分。术前血沉均有升高,平均61mm/h(34～80mm/h)。所有患者术前、术中均进行细菌培养和药敏试验。11例中一期翻修6例,二期翻修5例,术后均置引流管引流并根据药敏试验应用抗生素。11例患者早期感染2例,晚期感染9例。术前穿刺及窦道脓液培养阳性8例,其中5例为表皮葡萄球菌,2例为大肠埃希氏菌,1例为金黄色葡萄球菌。结果术后11例患者随访12～31个月,平均17个月,感染均未复发,血沉、血常规检查正常,术后Harris评分为79～92分,平均84.2分,较术前平均提高51.2分(P<0.05)。结论髋关节置换术后感染,只要诊断明确,合理使用抗生素和抗生素骨水泥,一期翻修同样可以取得满意的临床疗效。

Revision for infected total hip arthroplasty

Objective To discuss operative treatment of the postoperative infection after total hip arthroplasty. Methods 11 cases of infected hip arthroplasty, 6 males and 5 females, with a mean age of 63 years old (from 54 to 71 years), were treated operatively in our department. Their preoperative mean Harris score was 33 (from 25 to 40), and their mean erythrocyte sedimentation rate (ESR) was 61 mm/h (from 34 to 80 mm/h). Bacterial cultures and drug susceptibility tests were carried out before and during operation. One- stage revision was performed for 6 cases, and two- stage revision was performed for 5 cases. Of the 11 cases, 2 were classified as early postoperative infection and 9 as late chronic infection. Preoperative microorganism cultures of joint aspiration or pus in sinus were positive in 8 cases but negative in 3 cases. 5 had staphylococcus epidermidis infection, 2 had escherichia coli infection and 1 had staphylococcus aureus infection. Results No recurrence of infection was found after a mean follow- up period of 17 months (from 12 to 31 months). ESR and blood tests after operation revealed nothing abnormal. The mean Harris score increased significantly to 84.2 (from 79 to 92) after revision (P< 0.05). Conclusion To treat the postoperative infection after total hip arthroplasty, one- stage revision can achieve satisfactory clinical outcome as long as diagnosis is correct, debridement is thorough, and use of antibiotics and antibiotic- loaded cement is rational.