二期翻修治疗人工髋节假体周围感染

摘要

目的 探讨人工髋关节置换术后假体周围感染二期翻修手术疗效和假体再植入时机.方法 回顾性分析自2006年1月～2010年1月在我院采用二期翻修术治疗人工髋关节术后感染15例(15髋).一期手术彻底清创,取出感染假体,植入自制万古霉素骨水泥占位器;3～6月后二期手术,再次清创,取出骨水泥占位器后,9例植入骨水泥型,6例植入非骨水泥型假体.术后随访9～46个月(平均25个月).结果 15例患者均未发现感染复发、假体松动和脱位等.治疗前Harris评分平均为40.3分(22～55分),一期手术后Harris评分平均为54.0分(45～65分).二期翻修后Harris评分平均为88.2分(68～94分).结论 二期翻修手术治疗人工髋关节置换术后假体周围感染,能有效控制感染,关节功能明显改善,临床效果满意.一期手术后间隔3～6月再二期手术为恰当的手术时机.%Objective To evaluate the efficacy and optimal re-implantation time of two-stage revision for management of periprosthetic infection following hip arthroplasty. Methods We retrospectively analyzed the clinical data of 15 patients (15 hip joints) undergoing two-stage ipsilateral total hip arthroplasty (THA) revision from January, 2006 to January, 2010. In the first stage, after surgical debidement and thorough removal of all the implants, a self-made Vancomycin-loaded cement spacer was implanted. The second stage operation was performed 3-6 months later for debridement and removal of the antibiotic-loaded spacer, followed by reimlpantation of Vamcomycin-loaded bone cement prosthesis in 9 cases and cementless prosthesis in 6 cases. The patients were followed up for 9-46 months (mean 25 months) after the operation. Results No reinfection or prosthesis loosening/displacement was found in these cases after the operation. The Harris score increased from 40.3 before the operation to 54.0 after the first-stage operation, and to 88.2 at the last follow-up. Conclusion Two-stage revision is effective for treatment of periprosthetic infection following hip arthroplasty, and 3-6 months can be the optimal interval between the two the first-stage and second-stage operation for re-implantation.