关节感染后继发性骨关节炎人工关节置换治疗的初步探讨

目的探讨关节感染后继发骨关节炎患者行初次人工关节置换术的特点及治疗原则。方法回顾性分析既往有关节感染史的15例初次全髋和全膝关节置换术病例，其中化脓性感染5例，结核性感染10例。全髋关节置换7例，全膝关节置换8例，手术时平均年龄（53．5±7．7）岁，感染平均静止（41．5±35．8）个月。行关节置换术前常规进行白细胞计数、血沉、c反应蛋白检查，并穿刺取关节液、滑膜组织等进行细菌培养以明确感染活动状态。结果所有病例术前白细胞计数、血沉、c反应蛋白正常，关节液、滑膜组织细菌培养阴性，组织学检查明确关节无活动性感染。采用一期关节置换，无论膝关节还是髋关节，均获得满意的关节功能恢复，术后随访（2．6±1．6）年，随访过程中均未出现感染复发。结论关节感染后继发骨关节炎病例，通过血清免疫学检查、关节液、滑膜组织细菌培养、组织学检查排除活动性感染，保持静息状态相当一段时间后行一期关节置换，可明显改善关节活动功能，取得较好的临床效果。

Clinical analysis of primary joint replacement for secondary osteoarthritis due to joint infection

Objective To evaluate the features and principles of primary joint replacement for the secondary osteoarthritis due to the prior joint infection. Methods 15 cases of total hip （ n = 7 ） or knee （ n= 8 ） arthroplasties after joint infection （ five cases of suppurative infection and 10 cases of tuberculosis） were retrospectively reviewed. The mean patient age was 53.5 （ SD = 7. 7 ） years when the arthroplasties were performed. The mean interval between the eradication of the infection and the arthroplasties was 41.5 （ SD = 35.8 ） months. White blood cell count, erythroeyte sedimentaion rate and C-reactive protein level were examined preoperatively. The needle biopsy of the joint was carried out to obtain joint fluid and synovial tissue for culture and histological analysis as well. Results All the results of white blood cell counts, erythrocyte sedimentaion rates and C-reactive protein levels were within normal range. All the cultures were negative. The histological examination revealed no sign of active infection. All the patients underwent total hip or knee arthroplasty. During the follow-up period （2. 6 ± 1.6 years）, all the patients gained a satisfying functional recovery of the affected joint and no infection recurrence emerged. Conclusion The osteoarthritis secondary to the joint infection can be treated by arthroplasty to achieve favorable function recovery. There should be a sufficient interval between the eradication and the arthroplasty. Before the arthroplasty, the infected cases should be excluded by the serum examination, the joint-fluid or synovial-tissue culture and histological analysis.