定制抗生素骨水泥临时假体在人工髋关节置换术后感染二期翻修中的应用

目的报道应用定制抗生素骨水泥临时假体治疗人工髋关节置换术后感染的手术疗效。方法16例取出人工髋关节假体彻底清创后,放置形状及大小与髋臼及股骨髓腔大小相匹配的抗生素骨水泥临时假体,术后定期复查C反应蛋白和血沉,待结果正常后二期行人工髋关节翻修术。结果抗生素骨水泥临时假体充填后,患者伤口均愈合,1~2周后可扶双拐不负重活动,术后无一例发生骨水泥临时假体断裂及脱位,双下肢长度基本对称,二期翻修时抗生素骨水泥假体均可顺利取出。术后人工关节无一例感染复发、松动及下沉,Harris评分平均81分。结论定制抗生素骨水泥临时假体对感染的人工髋关节进行二期翻修,方法可靠,术后复发率低,能有效地克服髋周软组织挛缩,最大限度地保留下肢功能。

Revision for Hip Arthroplasty Infection with A Custom - made, Antibiotic- loaded, Cement Prosthesis as An Interim Spacer for Two Stage Protocol

Objective To report the results of the treatment of deep infection of hip joint implants with a custom-made antibiotic-load cement prosthesis as an interim spacer. Methods Sixteen consecutive patients with deep infection of the hip prosthesis were treated according to a prospective,two-stage resection/reimplantation protocol. Between stages,a custom-made,antibiotic-load,cement prosthesis was implanted as an interim spacer,and reimplantation was taken only after the C-reactive protein and erythrocyte sedimentation rate returned to the normal levels. Results Infection was eradicated in 16 patients after the first-stage operation. All the patients remained with the ability to walk with the interim cement prosthesis after reimplantation recurrence of infection was not observed in all the patients at an average of six months'followed up period.Conclusion The two-stage treatment protocol is reliable approach for treatment of infected hip prosthesis. It is effective for eradicating infection and for providing a partial mobilized and functional joint through the treatment course.