人工关节置换术后感染的治疗

目的探讨人工关节置换术后感染的原因，处理方法和临床效果。方法白1992年1月～2004年2月年共收治7例人工关节置换术后感染患者，6例髋关节，1例膝关节。男性4例，女性3例；年龄43～74岁，平均58岁。术后感染发生在2个月内3例，1年内1例，2年以上3例（3、8、10年）。2例扩创，取出钢丝和捆绑带，置管持续冲洗，静点、口服抗菌素。1例取出假体，关节旷置。1例一期关节置换。3例二期关节置换。结果随访2～14年，平均随访8年，6例患者无感染复发迹象，疼痛消失，独立行走，关节功能满意。1例因拒绝取出假体，窦道反复破溃。结论应严格掌握关节置换适应证，预防感染重于治疗。术中病理切片检查对诊断感染，决定翻修手术的时机具有指导意义。

The treatment of postoperative infection after endoprostheses replacement

Objective To explore the causes of postoperative infection after joint replacement and correct treatment clinical results. Methods Seven cases of postoperative infection that underwent endoprostheses replacement were treated from Jan. 1992 to Feb. 2004. Of these, 6 cases were hip infections, 1 was a knee infection. The average age at operation was 58 years-old. The postoperative infection occurred within 2 months in 3 cases, 1 year in 1 case, and later than 2 years in 3 cases. Two cases underwent debridement to remove all metal wires and bands, continuous drainage, and antibiotics administration; 1 case underwent prosthesis removal; 1 case underwent one-stage revision, and 3 cases underwent two-stage revision. Results All cases were followed up with an average follow-up time of 8 years. Good results were achieved in 6 cases. Poor results were seen in 1 case where recurrent sinus sepsis occurred because the patient refused to remove her infected prosthesis. Conclusions First, it is recommended that the indications for joint replacement should be carefully assessed. The prevention of joint infection is more important than is its treatment. Second, the degree of pathology in the operation is indicative for the choice of revision