可吸收载药型硫酸钙治疗关节置换术后早期感染

目的探讨使用可吸收载药型硫酸钙治疗关节置换术后早期感染的临床疗效。 方法回顾性分析自2015年8月至2018年1月，选取中山市中医院骨三科关节置换术后早期感染患者9例，全部病例假体固定角度、位置良好，无假体松动，出现感染症状的平均时间为(10±3)d，全部病例均进行手术病灶彻底清创，保留关节假体，关节腔内置入可吸收载药型硫酸钙颗粒治疗。术中均进行关节周围软组织冰冻切片明确感染的诊断。采用配对样本t检验比较患者手术前后血象、红细胞沉降率、C反应蛋白、髋关节Harris评分。 结果9例中伤口分泌物细菌培养阳性6例，阴性3例。9例均获得随访，平均(21±4)个月，其中8例翻修后伤口愈合良好，假体固定牢固，感染得到控制，1例出现感染复发，假体松动。术后髋关节功能得到较大改善，翻修前Harris评分平均(32.0±7.6)分，翻修后Harris评分平均(87.2±7.7)分，差异有统计学意义(t ＝3.243，P<0.01)；翻修后红细胞沉降率与术前比较明显下降，差异有统计学意义(t＝2.117，P<0.01)，翻修后CRP与术前比较明显下降，差异有统计学意义(t＝3.344，P<0.01)。 结论关节置换术后早期感染采用保留假体的关节清创术，结合关节腔内置入可吸收载药型硫酸钙颗粒，选择好适应证，效果良好。

Absorbable drug-loaded calcium sulfate for early postoperative infection of joint replacement

ObjectiveTo investigate the clinical effect of absorbable calcium sulfate in the treatment of early infection after joint replacement. MethodsFrom August 2015 to January 2018, in Orthopedics Department of Three, Zhongshan Hospital nine patients with early infection after joint replacement were selected for a retrospective analysis. All the cases showed good prosthesis location, without prosthesis loosening. The infection symptoms last for an average period of (10±3)d. All the patients adopted thorough debridement, retaining joint prosthesis. The absorbable drug-loaded calcium sulfate particles were inserted into the articular cavity. During the operation, frozen sections of periarticular soft tissue were taken to confirm the diagnosis of infection. Paired sample t test was performed to compare the routine blood test, erythrocytes sedimentation (ESR), C-reactive protein (CRP), Harris hip score, before and after surgery. ResultsThe wound secretion germiculture showed six cases of positive, three cases of negative. All the nine patients were followed up for an average period of (21± 4) months. After the revision, the wounds of eight patients healed well, the prostheses were fixed firmly, and the infections were controlled. The function of hip joint was significantly improved, with Harris score improved from(32.0±7.6) to (87.2±7.7), and the difference was statistically significant (t=3.243, P <0.05). ESR(t=2.117) and CRP(t=3.344) also improved with significance(both P<0.01). ConclusionJoint debridement with reserved prosthesis and the placement of absorbable drug-loaded calcium sulfate particles in the joint cavity can be used for the early infection after joint replacement.