全髋关节置换术后感染的二期翻修术

目的全髋关节置换术后感染是全髋关节置换的最严重并发症,给后期的进一步治疗造成许多困难。本文着重讨论全髋关节置换术后感染的二期翻修方法。方法自1998年9月～2000年3月,共治疗全髋术后感染病例7例,其中男2例,女5例;年龄42～68岁,平均51.5岁。早期感染2例,晚期感染4例和急性血源性感染1例。3例致病菌为金黄色葡萄球菌,1例为产碱假单胞菌,3例细菌培养阴性。所有病例都采用清创、假体取出后二期翻修的治疗方法。结果7例病例在初次清创假体取出,含庆大霉素、万古霉素抗生素的骨水泥间隔物置入后,伤口均Ⅰ期愈合。二期手术间隔时间平均11.7个月,翻修术后随访平均7.2个月,未出现感染征象。结论全髋关节置换术后感染二期翻修具有安全系数高,感染容易控制的优点,近期临床疗效满意。

Prothetic revision in two stages for infected total hip arthroplasty

Objective Postoperative infection after total hip arthroplas ty (THA) is the most severe complication resulting in failure of the procedure. Usually further treatment is difficult especially in presence of postoperative i nfection. This paper is mainly to focus on the emphasis of the management of inf ected THA with prothetic revision in two stages. Methods Seven cases of postoper ative infected THA were treated from September1998 to March 2000. There were 2 m ales and 5 females with the average age of 51.5 years old (range 42- 68 ) . Two cases were classified as early postoperative infection, 4 cases late chron ic infection and 1 case acute hematogenous infection. Three cases of staphylococ cus aureus infection and one of pseudomonas alcaligenes were confirmed, while th e others had negative results in bacterial culture. Debridement, removal of infe cted prothesis and secondary prothetic reimplantation were carried out in all th ese cases. Results Seven patients obtained primary healing of incision after the first debridement and the implantation of cement spacer mixed with gentamycin a nd vancomycin. The interval between primary and secondary procedures was 11.7 mo nths in average. No sign of postoperative recurrent infection was found in these cases with the mean follow up of 7.2 months. Conclusion Prothetic revision in two stages after infected THA is with superior safety and with the advantage in controlling the infection. The clinical results are excellent. [