人工髋关节置换后感染二期翻修中的彻底清创

摘要

背景：感染是人工全髋关节置换后灾难性的并发症，其诊断标准尚未统一，治疗方案亦存在争议。髋关节置换后感染灶的清除彻底与否决定能否重建关节并恢复关节功能。　　目的：分析髋关节置换后感染二期翻修过程中彻底清创的经验及疗效。　　方法：2008年8月至2013年1月解放军南京军区南京总医院骨科收治23例(24髋)髋关节置换后感染病例，均符合共识性的诊断标准，修复方案分两期，一期彻底清创加含抗生素骨水泥间隔置入；二期行关节重建，若间隔期感染持续存在，可以重复清创，待感染彻底控制后行关节重建。翻修后随访期间行髋关节功能Harris评分，并评估感染控制情况。　　结果与结论：所有患者均获得随访，随访时间1-5年，治疗前Harris评分平均为36.5分(27-45分)，二期翻修后Harris评分平均为88.6分(76-98分)，且均无感染复发，感染控制率达100%。提示二期翻修是治疗髋关节置换后感染的有效方法，彻底清创可起到至关重要的作用，能有效控制感染复发，提高假体稳定性，从而重建关节功能。%BACKGROUND:Infection is the catastrophic complication after total hip arthroplasty, moreover, its diagnostic criteria has not been unified, and treatment options were also controversial. The removal of the focus of infection was complete or not determines whether the joint could be reconstructed and the joint function could be restored. OBJECTIVE:To analyze the experience and efficacy of thorough debridement in two-stage revision surgery for treatment of infection after hip arthroplasty. METHODS:Total y 23 (24 hips) patients with infection after hip arthroplasty were treated at the Department of Orthopedics, Nanjing General Hospital of Nanjing Military Area Command of PLA from August 2008 to January 2013. The diagnostic criteria were in line with consensus. The repair options defined as two phrases:the first phrase was thorough debridement plus antibiotic-containing bone cement implanted with intervals;the second phrase was joint reconstruction. If the infection persisted in interval, debridement could be repeated, and then underwent joint reconstruction after the thorough control of infection. Harris scores of hip function were determined after revision during fol ow-up. Infection control condition was evaluated. RESULTS AND CONCLUSION:Al the patients were fol owed up, ranged from 1 to 5 years. The Harris scores increased from an average of 36.5 (27-45 scores) before treatment to an average of 88.6 (76-98 scores) after treatment. There was no infection recurrence. Infection control rates reached to 100%. These results suggest that two-stage revision is an effective method for treatment of infection after total hip arthroplasty. Thorough debridement plays a crucial role, and it can effectively control infection recurrence, improve prosthesis stability, so as to reconstruct joint function.