应用抗菌素骨水泥旷置分期翻修治疗人工髋关节置换术后感染

目的 评估应用抗菌素骨水泥旷置分期翻修（TSEA）治疗髋关节置换术后感染的疗效。方法 1998年1月～2005年1月，采用TSEA治疗8例髋关节置换术后感染患者，所有患者均行细菌培养检查，一期清创假体取出滴注2例，清创后假体取出加PR-40抗菌素骨水泥支架旷置6例；二期翻修采用非骨水泥假体3例，骨水泥型假体3例，混合髋2例；手术前后髋关节功能通过Harris评分评估。结果 4例细菌培养为金黄色葡萄球菌，3例为混合感染，1例细菌培养阴性。一期处理后所有伤口均愈合，一、二期平均间隔5．5个月。术后平均3年4个月随访时髋关节Harris评分由术前31．1分提高至62．9分。结论 TSEA是治疗髋关节置换术后感染非常有效的方法，其中碘氟浸泡髓腔和抗菌素骨水泥旷置是主要手段。骨水泥复合万古霉素对耐受甲氧西林金黄色球菌人工关节感染治疗有效。

Treatment of infected hip using antibiotic-impregnated cement spacer by two-stage exchange arthroplasty

Objective To assess the effects of two-stage exchange arthroplasty (TSEA) in the treatment of infected hips following replacement using antibiotic-impregnated cement spacer. Methods At the first stage of TESA, after the debridement and removal of primary prostheses, antibiotic instillation was applied in 2 infected hips and the PR-40 cement spacer (Gentamicin impregnated) in 6. At the second stage, 3 noncemented prostheses, 3 cemented ones and 2 hybrid components were applied. The hip functions before and after operation were evaluated by Harris scores. Results The bacterial culture revealed staphylococcus aureus infection in 4 hips, mixed infection in 3 and negative in 1. The average time of follow-up was 3 years 4 months and the interval between the two stages averaged 5. 5 months. After the first procedure, all the wounds closed smoothly and no further infection occurred. The mean Harris hip scores at the last follow-up improved from preoperative 31. 1 points to postoperative 62. 9 points. Conclusions TSEA is a very effective treatment of the infected hip following replacement. PR-40 cement is responsive to most gram-positive or negative bacterial infections, and the vancomycin is more effective for methicilin-resistant staphylococcus aureus (MRSA) infections.