髋臼骨折内固定术后继发髋关节深部感染的全髋关节置换术

目的探讨全髋关节置换术（THA）治疗成人髋臼骨折术后继发髋部深部感染的近期临床疗效。方法回顾性分析2009年8月至2012年12月采用THA手术治疗8例成人髋臼骨折术后继发髋部深部感染的临床资料,男5例,女3例;年龄38-51岁,平均45岁。前柱骨折1例,后柱并后壁骨折4例,横行骨折2例,横行伴后壁骨折1例。术前行关节穿刺及术中取关节周围组织送细菌培养和药敏试验。手术取出内固定物,彻底清创,1例行一期THA手术,7例采取一期植入抗生素骨水泥间隔体,术后静脉滴注及口服抗生素,定期复查红细胞沉降率（ESR）、C反应蛋白（CRP）连续两次正常后,行二期THA手术。术后定期随访,常规复查ESR、CRP,摄髋关节正侧位X线片,采用Harris髋关节评分评估髋关节功能。结果所有患者均获得随访,随访时间14-55个月,平均29.5个月。一期与二期手术间隔时间5-15个月,平均8.5个月。Harris髋关节评分从术前平均（53.8±4.9）分,提高至末次随访时平均（92.3±5.3）分,差异有统计学意义（t=33.14,P〈0.01）。随访期间无1例发生假体周围感染、假体松动及脱位。结论对继发于髋臼骨折内固定手术的髋部感染,彻底清创及应用抗生素骨水泥间隔体可有效控制感染,骨小梁金属钽杯可提供有效的骨长入。

Cementless total hip arthroplasty for chronic deep hip infection following acetabular fracture fixation

Objective To retrospectively analyze the short-term clinical effects of the cementless total hip arthroplasty（THA） in the treatment of chronic hip infection following the internal fixation of the acetabular fracture in adults.Methods From August 2009 to December 2012,eight patients who had suffered the chronic hip infection following the internal fixation of the acetabular fracture,were treated with THA.There were five males and three females,aged from 45 to 94 years（average,61.2 years）.Among them,one was anterior acetabular fracture and seven were posterior acetabular column fracture.After the surgical debridement and removal of all the metal implants,one case accepted THA in one stage,while the other seven cases were treated with an antibiotic-loaded cement spacer in the first stage.When the values of erythrocyte sedimentation rate（ESR） and C-reactive protein（CRP） become normal,the total hip arthroplasty was performed in the second stage for the seven patients.All the patients were followed up regularly;ESR and CRP were tested.Harris score was used to evaluate the function of the hip.Results All the patients were followed up for an average time of 29.5 months（range,14 to 55months）.The interventional time of the second stage arthroplasty was 5 to 15 months（average,8.5 months）.The Harris hip score improved from preoperative（53.8 ± 4.9） to（92.3 ± 5.3） at the final follow-up.No re-infection,component loosening and dislocation occurred after THA.Conclusion Debridement and antibiotic-loaded cement spacer are effective methods for treating the chronic hip infection following the internal fixation of the acetabular fracture.Tantalum monoblock acetabular cup can offer effective bone in-growth.