关节置换术后感染非组配式广泛涂层股骨柄二期翻修术的中期疗效

 目的 探讨应用非组配式广泛涂层股骨柄行关节置换术后感染二期翻修术的中期疗效。方法 回顾性分析2005年3月至2006年12月接受全髋关节置换术后感染二期翻修的33例（33髋）患者的病例资料，男20例，女13例；年龄52~80岁，平均（66.1±7.2）岁。二期翻修方案包括一期取出关节假体，彻底清创，置入自制抗生素骨水泥间隔体，抗感染治疗后行二期关节翻修术。抗感染治疗包括静脉抗感染治疗4周、口服抗生素6周。采用美国骨科医师学会（American Academy of Orthopaedic Surgeons，AAOS）分类法评估髋臼骨缺损，Paprosky分类法评估股骨骨缺损。采用Harris髋关节评分评估髋关节功能，术后定期复查X线片评估假体稳定性、移位、松动情况。根据DeLee和Charnley分区法记录髋臼假体周围透光线，根据Gruen分区法记录股骨柄周围透光线。采用Engh等标准评价股骨假体固定情况。再感染的标准与诊断关节感染的标准相同。结果 全部病例随访5~9年，平均（6.1±1.7）年。二期翻修术后无一例出现感染或假体松动。二期翻修术中所取标本微生物培养或病理学检查均为阴性。Harris髋关节评分由术前（42.3±6.5）分提高到末次随访的（89.1±8.5）分。股骨柄骨长入固定30例，纤维稳定固定3例。11例髋臼侧打压植骨和所有股骨髓腔内打压植骨均与宿主骨融合。股骨侧异体皮质骨板移植者10例，9例于二期翻修术后1年与宿主骨融合、1例于术后2年融合。结论 采用非组配式广泛涂层股骨假体行感染二期翻修结合髓腔内颗粒骨打压植骨能取得较好的假体中期生存率和感染清除率。

Medium-term curative effect of extensively coated non-modular femoral stem in two-stage infection revision after joint replacement

Objective To determine medium-term curative effect of extensively coated non-modular femoral stems in two-stage infection revision after joint replacement. Methods We retrospectively analyzed 33 patients (33 hips) who had a two-stage infection revision after total hip replacement arthroplasty from March 2005 to December 2006. Among of them, there were 20 men (20 hips) and 13 women (13 hips). Their mean age was 66.1±7.2 years with a range from 52 to 80. The two-stage revision protocol consisted of joint prosthesis taken out in the first stage, thorough debridement, hand-molded antibiotic bone cement spacer, and two-stage joint revision after anti-infective therapy. Anti-infective therapy included intravenous antimicrobial therapy for 4 weeks and oral antibiotics for 6 weeks. Harris hip score (HHS) was used to evaluate functions of hip joint. X-ray films were used to perform clinical and radiological evaluations of prosthesis stability, displacement and looseness. Reinfection criteria were the same as the criteria used to diagnose the joint infection. Results Follow-up visit was carried out for all patients for 5-9 years (6.1±1.7 years on the average). No infection or prosthesis looseness happened after two-stage revision. Microculture of samples taken during two-stage revision or pathological examination was negative. Harris hip joint score rose to 89.1±8.5 in the last follow-up visit from preoperative 42.3±6.5. 30 patients achieved stable bone ingrowths and the remaining three had stable fibrous ingrowths. Impacted bone graft at acetabulum side for 11 patients and all impacted bone graft in marrow cavity were fused well with the host bones. Allogeneic cortical bone plate grafts were used in 10 hips on the femoral side. Nine of these cortical bone plates fused with the host bones after postoperative 1 year, whereas one fused after 2 years. Conclusion Using extensively coated non-modular femoral stems combined with intramedullary allograft in two-stage revision for treating infection can achieve satisfactory medium-term survival rate of prosthesis and infection clearance rate.