人工全髋关节置换术后感染翻修30例

目的探讨人工全髋关节置换术术后感染的细菌学特点、翻修策略、翻修术中常见的困难及对策。方法30例人工全髋关节置换术后感染患者，其中男12例，女18例；年龄31～86岁，平均62．5岁。感染发生时间为术后1个月～4年，平均为术后7个月。其中股骨颈骨折12例，股骨头坏死11例，骨关节炎5例，类风湿性关节炎2例。行Ⅰ期翻修术12例，Ⅱ期翻修术18例。结果翻修术前24例明确诊断为感染，其中细菌学明确诊断18例，其中表皮葡萄球菌5例，金黄色葡萄球菌4例，其他细菌9例。术中标本细菌培养23例阳性，7例阴性。Ⅰ期翻修12例中10例患者得到随访，时间平均16个月，2例感染复发；Ⅱ期翻修中13例得到随访，时间平均20个月，1例感染复发。Harris评分术前平均为44分，随访截止时评分平均为84分。结论（1）耐药葡萄球菌是人工髋关节置换术后感染的主要病原菌；（2）术后感染翻修手术难度大，术前要做好周密的准备，没有手术经验的医师尽量不要尝试；（3）术后感染采用Ⅰ期或Ⅱ期翻修应根据患者具体情况决定，Ⅱ期翻修术后感染复发率较低；（4）抗生素骨水泥在人工关节感染翻修术中的应用可以提高疗效，有利于关节功能恢复；（5）术后科学的康复对功能恢复十分重要。

Revision of infected total hip replacement: a report of 30 cases

Objective To retrospectively study revisions for infected total hip replacements in 30 cases and discuss the bacteriological characters of the infected total hip replacements,difficulties and strategies in the revision.Methods Thirty revisions of infected total hip replacements were reviewed retrospectively.There were 12 males and 18 females,with mean age of 62.5 years(31-86 years)at revi- sion surgery.Infection was presented one month to four years(mean seven months)after THA operation. The diseases for initial operation included femoral neck fractures in 12 cases,femoral head necrosis in 11,hip osteoarthritis in five and rheumatoid arthritis in two.Twelve eases were treated by one-stage revi- sion and 18 by two-stage revision.Results Before the revision operation,the hip infection were diag- nosed by bacterial culture in 18 cases including five with Staphylococcus epidermidis,four with Staphylo- coccus aureus and nine with other bacteria.Bacteria growth appeared on the specimens from 23 hip joints during the revision surgery but not on the specimens from seven hip joints.Of 12 one-stage revisions,10 cases were followed for mean 16 months,which showed infection recurrence in two eases.Of 18 two-stage revisions,13 cases were followed for mean 20 months,which showed one case with infection recurrence. The mean Harris hip score was improved from preoperative 44 to 84 at follow-up.Conclusions 1) The main bacteria in the infected hip are antibiotic resistant Staphylococcus.2)Because the revision op- eration is difficult,careful preparation before revision is important for success.The fresh surgeon should not attempt.3)The revision strategies should vary according to specific status of the cases.The infection recurrence rate is lower when using a two-stage revision strategy.4)Application of antibiotic bone cement can help improve treatment effect and facilitate functional recovery of the joints.5)The scientific rehabil- itation after operation is very important to functional recovery.