摘要
目的探讨全髋型与半髋型抗生素骨水泥占位器在髋关节感染二期翻修术中的临床疗效。方法广州中医药大学附属中山市中医院骨三科2011年10月至2016年3月,共收治的16例18髋关节感染病例,按时间先后分成A、B两组进行治疗。A组7例7髋,术中制作半髋型抗生素骨水泥占位器;B组9例11髋,术中制作全髋型抗生素骨水泥占位器;全部病例均进行髋关节感染的一期病灶彻底清理,假体或异物取出、抗生素骨水泥占位器旷置,感染控制后二期再植入翻修假体,比较两组占位器在一期旷置术前术后二周的Harris髋关节评分、旷置术后卧床时间、二次翻修术前并发症发生率、二次翻修术前、术后的感染控制率等指标。采用SPSS 17.0统计分析,计量资料用采用t检验。计数资料采用Fisher确切概率法,以P<0.05为差异有统计学意义。结果术后随访时间5~53个月。A组7例半髋型占位器一期旷置术后,脱位和继发骨缺损发生率42.8%;并发症发生率71.4%;感染控制率85.7%;术后2周髋关节Harris评分由一期手术前39分提高至50分。B组9例11髋全髋型占位器,并发症发生率18.2%,感染控制率100%;一期术后2周髋关节Harris评分由一期术前40分提高至75分。两类占位器在二期翻修术前并发症发生率(P=0.039<0.05)、卧床时间(t=2.15,P<0.05)、术后2周Harris评分(t=1.841,P<0.05)差异均有统计学意义。结论在病灶彻底清创的基础上,两种类型的抗生素骨水泥占位器均有理想的感染控制率,全髋型较半髋型的并发症发生率低,利于减轻二次翻修手术的难度。
Objective To assess the clinical efficacy of antibiotic-impregnated cement spacers of total and half hip in two-stage revision for hip infection. Methods From October,2011 to March,2016,a total of 18 hip infections in 16 cases were divided into two groups according to the time order in orthopaedics department of the Affiliated Zhongshan Hospital of Guangzhou University of Traditional Chinese Medicine. The group A of seven hips in seven cases were antibiotic-impregnated cement spacers of half hip. The group B of 11 hips in nine cases were antibiotic-impregnated cement spacers of total hip. All the cases underwent the complete debridement of hip infection,the prosthesis or foreign body removal,exclusion of antibiotic-impregnated cement spacer,and the implantation of revision prosthesis after the infection was controlled. The Harris hip scores,postoperative bed time,preoperative complication rate,preoperative complication rate,and postoperative infection control rate of the two groups were compared during the transition period. SPSS 17. 0 analysis software was used for statistical analysis. The t test was used for metering data while the Fisher ＇s exact probability method was adopted for the count data. The statistically significant difference was set as P 0. 05. Results All the patients were followed up 5-53 months. After one-stage exclusion,the group A showed the dislocation and secondary bone defect rate of42. 8%,complication rate of 71. 4% and infection controlled rate of 85. 7%; while the group B showed the dislocation and secondary bone defect rate of 9. 1%,complication rate of 18. 2% and infection controlled rate of 100%. Harris hip scores were improved from 39 to 50 in group A,and 40 to 75 in group B at two weeks following the one-stage exclusion. There were statistically significant differences between the two groups in the preoperative complications of the second phase revision（ P = 0. 039 0. 05）,postoperative bed time（ t = 2. 15,P 0. 05）,and the Harris hip scores at two weeks after surgery（ t = 1. 841,P 0. 05）. Conclusions Based on the complete debridement,both the two types of performed antibiotic bone cement spacers present good infection control rate,low complication rate and easy implementation of twostage revision. The complication rate of total hip is lower than that of half hip,which is beneficial for reducing the difficulty of secondary revision surgery.
出处
《中华关节外科杂志（电子版）》
CAS
2017年第4期10-15,共6页
Chinese Journal of Joint Surgery(Electronic Edition)
基金
中山市科技计划项目(2015B1047)
