髋部手术继发髋关节感染的二期全髋关节置换

 目的 探讨应用抗生素骨水泥间隔体二期全髋关节置换治疗髋部手术继发髋关节感染的疗效。方法 从2005年1月至2010年1月应用二期全髋关节置换连续治疗髋部手术继发髋关节感染患者6例，男2例，女4例；年龄43～68岁，平均(59.7±9.2)岁。股骨颈骨折行加压螺钉固定3例，股骨头坏死骨瓣移植1例，早期股骨头坏死行中心钻孔减压及局部介入治疗各1例。一期手术彻底清创，植入抗生素(万古霉素)骨水泥间隔体，感染控制后二期植入全髋关节假体。术后定期随访，常规复查红细胞沉降率(erythrocyte sedimentation rate，ESR)、C反应蛋白(C-reactive protein，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24～81个月，平均46个月。5例患者在一期清创后平均14周(12～18周)行二期全髋关节置换，1例患者在一期清创后7个月行二次清创及重新植入骨水泥间隔体，12周后行二期全髋关节置换。Harris髋关节评分从术前平均(35.6±3.3)分，间隔期平均(57.8±5.4)分，提高至末次随访平均(92.3±5.7)分，差异有统计学意义。1例患者于间隔期出现下肢深静脉血栓形成及左下肺栓塞。随访期间未出现感染复发及新发感染病例。结论 对继发于髋部手术的髋关节感染，应用抗生素骨水泥间隔体行二期全髋关节置换可以获得较满意的近中期疗效。

Two-stage exchange total hip arthroplasty for infected hip surgery

Objective To evaluate effect of two-stage exchange total hip arthroplasty (THA) using an antibiotic-loaded cement spacer in the treatment of hip infection secondary to hip surgery. Methods From January 2005 to January 2010, 6 consecutive patients with infected hip secondary to hip surgery, including 2 males and 4 females, aged from 43 to 68 years (average, 59.7?9.2 years) were treated with two-stage exchange THA. There were 3 cases of femoral neck fracture treated with compression screws fixation, 1 case of femoral head necrosis treated with bone graft, and 2 cases of early stage femoral head necrosis treated with core decompression and local interventional therapy respectively. Debridement and insertion of antibiotic-loaded cement spacer was performed in the first stage. After eradication of infection, it was converted to THA in the second stage. All patients were followed up regularly. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. Harris score was used to evaluate the function of the hips. Results All patients were followed up for an average of 46 months (range, 24 to 81 months). Five of 6 patients were successfully converted to THA after an average of 14 weeks. One patient accepted the second debridement and reinsertion of a spacer owing to the abnormal values of ESR and CRP; this case was converted to THA successfully 12 weeks after the second debridement. Harris hip score improved from preoperative 35.6?3.3 to 57.8?5.4 between the two stages and 92.3?5.7 at final follow-up. One patient suffered deep vein thrombosis in the infected extremity and pulmonary embolism. There was no reinfection after THA. Conclusion Two-stage exchange THA using an antibiotic-loaded cement spacer can obtain satisfactory results for the treatment of hip infection secondary to the hip surgery.