临时占位器在治疗髋关节置换术后感染伴窦道形成中的应用

目的探讨髋关节置换术后感染伴窦道形成的治疗方法。方法 12例(13髋)髋关节置换术后感染伴窦道形成患者,术前Harris评分平均30(23~38)分,血沉平均54(38~74)mm/h。根据Fitizgerald全髋关节置换术后感染分期,2例为Ⅰ期感染,8例为Ⅱ期感染,2例为Ⅲ期感染。12例均行一期清创、假体取出、占位器植入手术,二期行翻修术10例,因经济原因放弃二期翻修2例。结果平均随访19(3~30)个月,10例翻修术前Harris评分平均74.6(69~89)分,较术前有明显提高(P0.05)。术后血沉平均10(6~17)mm/h,CRP降至正常范围,感染无复发。结论临时占位器治疗髋关节置换术后感染伴窦道形成方法可靠,术后复发率低,能有效克服髋周组织的挛缩。

Application of Revision Spacer in the Treatment of Chronic Infection Combined with Sinus Formation Due to Hip Replacement

Objective To discuss the therapeutic method of chronic infection with sinus tract formation after hip replacement.Methods 12 chronic infection cases with sinus formation due to hip replacement were reviewed,including 4 cases（4 hips） of femoral head prosthetic replacement and 8 cases（9 hips） of total hip arthroplasty（THA）.According to Fitizgerald infection staging system after THA,2 cases were stage Ⅰ,8 cases were stage Ⅱ and 2 cases were stage Ⅲ.The mean Harris score was 30 and the mean erythrocyte sedimentation rate（ESR） was 54 mm/h.All cases were treated by primary debridement,removal of infected prothesis and implantation of temporary spacer.Among them,8 cases were performed secondary stage revision,but 2 cases gave up two-stage revision due to economic reasons.Results All cases were followed up for 3 to 30 months with an average of 19 months.The mean Harris score was increased to 74.6 before two-stage revision,and was significant higher than that of preoperation（paired t-test,P0.05）.The ESR was 6 to 17 mm/h and C reactive protein was decreased to normal range after the operation.No recurrence was found.Conclusion The therapy of temporary spacer implantation and secondary prothetic implantation can eradicate infection rigourously and overcome the tissue contracture effectively,and it is a reliable approach for chronic infection with sinus tract formation associated with hip replacement.