二期翻修在人工髋关节置换术后感染治疗中的作用

[目的]探讨二期翻修手术在治疗人工髋关节置换术后感染的有效性、第二期翻修时假体的选择及异体骨植骨的可行性。[方法]运用二期翻修术治疗了24例(25髋)髋关节置换术后感染患者,9例采用灌注冲洗型占位器,16例采用抗生素骨水泥占位器。第二期重建时,16例采用生物固定髋臼,其中7例结合使用异体颗粒植骨;9例采用打压植骨技术。1例采用抗生素骨水泥固定假体;8例采用远端固定非骨水泥假体,其中4例结合使用异体支撑植骨;16例采用打压植骨技术。应用X线片及Harris评分进行评价。[结果]所有患者均获得随访,平均随访时间26.3个月(3~57个月),Harris评分从术前平均47.9分,提高到最后随访时的平均86.7分,患者满意率为92%。在最后随访时没有感染复发的病例。[结论]二期翻修手术是治疗人工髋关节置换术后感染的有效方法,临时占位器起到至关重要的作用,使用抗生素骨水泥占位器有控制感染效果好、术后抗生素使用时间短及术后不用灌注的优点。在第二期翻修重建时可以使用非骨水泥假体,并且可以同时进行异体骨植骨。

Role of two-stage THA revision in the treatment of infected total hip arthroplasty

Objective To investigate the efficacy of two-stage THA revision in the treatment of infected total hip arthroplasty,the selection of prostheses and the possibility of using allograft in the second operation.[Method]A total of 24 patients(25 hips) were treated with two-stage revision from 2002~2006.Among them,Antibiotic irrigating metal articulating spacers were used in 9 cases,antibiotic loaded cement spacers were used in 16 cases.For the cup revision,noncemented cups were used in 16 cases in the second operations,8 of which were combined with moserlized bone allograft,and impaction bone grafting technique were used in 9 cases.For the femur revision,cemented component was use in 1 case,noncemented components with distal fixation were used in 8 cases,4 of which were combined with strut allograft,and impaction bone grafting technique were used 16 cases.The outcomes were evaluated by using the Harris Hip Score System and radiograph.[Result]All patients were followed up clinically and radiographically for an average of 26.3 months(3~57 months).No infection reoccurrence was found at the last time of follow-up.The mean Harris Hip Score was increased from 47.9 points before operations to 86.7 points after operations.92% of the patients were satisfied with the results.[Conclusion]The two-stage revision is effective method in the treatment of infected total hip replacement.Temporal spacer had a great role in the procedure,antibiotic loaded cement spacer had more advantages than other type of spacer.Noncemented components and allograft could be used in the second reconstructive operations.