翻修术治疗细菌培养阴性的全髋关节置换术后假体周围感染

摘要

Objectives To compare the effect of one-stage revision and two-stage revision for the treatment of culture-negative peripros-thetic joint infection after total hip arthroplasty.Methods A retrospective study was conducted with the clinical data of 41 patients who had chronic periprosthetic joint infection after total hip arthroplasty and then underwent one or two-stage revision surgery from February 2006 to February 2014.The patients were divided into two groups according to different surgical way,namely the 16 patients who received the one-stage revision surgery were regarded as the OSR group,and the other 25 cases who underwent the two-stage revision surgery were regarded as the TSR group.The clinical efficacy of the two surgical way were assessed with Harris Hip score,visual analogue scale (VAS),and rate of infection clearance.Results The average duration of follow up was 29.7 months (9 to 48 months).At the last follow-up,Harris Hip score of TSR group was higher than that of the OSR group,and the difference was statistically significant (P =0.04),and the VAS score of TSR group was lower than that of the OSR group with statistical differences (P =0.02).Additionally,the rate of infection clearance in TSR group was significantly higher than OSR group (P =0.04).Conclusion Culture-negative periprosthetic joint infection can be effectively controled by one or two-stage revision surgery.However,patients got a better prognosis after two-stage revision surgery.%目的：比较一期和二期翻修手术治疗细菌培养阴性的全髋关节置换术后假体周围感染的临床疗效。方法回顾性分析2006年2月至2014年2月在我院接受治疗的细菌培养结果为阴性的全髋关节置换术后假体周围感染41例患者的临床资料，根据手术方式分为2组，将接受一期翻修术的16例设为 OSR 组，将接受二期翻修术的25例设为 TSR 组。采用髋关节 Harrris功能评分、疼痛 VAS 评分、感染清除率评估2组疗效。结果平均随访时间29．7个月（9～48个月），末次随访 TSR 组 Harris 评分高于 OSR 组，2组比较差异有统计学意义（P ＝0．04），TSR 组 VAS 平均评分低于 OSR 组，2组比较差异有统计学意义（P ＝0．02）。TSR 组感染清除率高于 OSR 组，2组比较差异有统计学意义（P ＝0．04）。结论一期翻修术和二期翻修术均可较好控制细菌培养阴性的全髋关节术后假体周围感染，但二期翻修术后感染清除率及髋关节功能优于一期翻修术。