微生物培养结果对THA术后慢性假体周围感染二期翻修术疗效的影响

目的:探讨全髋关节置换(total hip arthroplasty,THA)术后慢性假体周围感染(periprosthetic joint infection,PJI)患者的微生物培养结果对二期翻修术疗效的影响?方法:回顾性分析中国人民解放军北京军区总医院收治的48例行二期翻修术治疗的THA术后慢性PJI(共48髋)患者的临床资料?所有患者一期清创手术时取出假体并置入万古霉素骨水泥占位器;待感染控制后应用骨水泥型假体进行二期翻修,术后应用敏感抗生素治疗?疗效评估指标为控制感染耗时?感染复发率?疼痛评分(visual analog scale,VAS)?Harris髋关节评分以及常规X线检查结果?结果:细菌培养阳性(culture positive,CP)35例,培养性阴性(culture negative,CN)13例?一期清创术后所有患者的感染均得到控制,CN组控制感染耗时较CP组长(119.3 ± 30.1)d vs.(98.4 ± 25.9)d,P=0.03];二期翻修术后门诊随访9~49个月(平均29.6个月),末次随访时所有患者的髋关节功能和疼痛较术前均有明显改善?但CN组疼痛VAS评分显著高于CP组(2.8 ± 1.6)分 vs.(1.8 ± 1.2)分,P=0.03]?髋关节Harris评分显著低于CP组(79.1 ± 9.1)分vs.(85.6 ± 7.1)分,P=0.01],术后优良率也明显较CP组低(53.8% vs. 85.7%,P=0.04)?CN组和CP组各有2例复发,但两组感染复发率差异无统计学意义(15.4% vs. 5.7%,P=0.62)?结论:采用二期翻修术可有效控制THA术后的慢性PJI,但CN患者的翻修术疗效明显较CP患者差?推测提高病原微生物的检出率并针对性应用敏感抗生素可能对改善PJI翻修术疗效有重要意义?

Influence of microbial culture results on the effect of two-stage revision surgery in chronic periprosthetic joint infection after total hip arthroplasty

Objective:To evaluate whether the microbial culture results of fluid or tissue obtained from the affected joint in patients with chronic periprosthetic joint infection (PJI) after total hip arthroplasty (THA) affect the effect of two-stage revision surgery. Methods:A retrospective study including 48 patients who underwent two-stage revision surgery with chronic PJI after THA from General Hospital of Beijing Military Region was conducted. The first stage comprised prosthesis extraction,radical debridement and insertion of vancomycin-loaded cement hip spacer. After eradicating the infection,a cementless THA was implanted in the second stage. Postoperatively,all patients were received sensitive antibiotics via intravenous drip for 6 weeks. Patients were assessed for infection control time,infection recurrence,pain evaluationvisual analog scale(VAS)]and hip joint function evaluation(Harris Hip score). X-ray photograph was routinely performed. Results:The numbers of microorganism in the culture-negative (CN)group and bacteria culture-positive(CP)group were 13 and 35,respectively. After debridement revision in the first stage,infection was controlled in all patients. The time for controlling infection in the CN group was longer than that in the CP group(119.3 ± 30.1)d vs. (98.4 ± 25.9)d,P=0.03]. The average duration of follow-up was 29.6 (range,9~49)months in outpatient department. At last follow-up,Harris hip score and pain VAS score were significantly improved compared with preoperation in all patients. Compared with the CP group,patients in the CN group were with a higher pain VAS score2.8 ± 1.6 vs. (1.8 ± 1.2),P=0.03],a lower Harris function score(79.1 ± 9.1) vs. (85.6 ± 7.1),P=0.01]as well as excellent and good rate53.8% vs. 85.7%,P=0.04]. There were 2 cases of recurrence respectively in the CN group and CP group,but no statistical difference of recurrence rate was observed between the two groups15.4% vs. 5.7%,P=0.62]. Conclusion:Satisfactory outcomes can be obtained with two-stage revision using vancomycin-loaded cement hip spacers and cementless implants for prosthetic hip joint infections. However,microbial culture results may affect the efficacy of two-stage revision in PJI patients,patients with a culture negative result may get a poor prognosis. The improvement of the detection rate of microoganism and application sensitive antibiotics may have a profound meaning on the effect of PJI.