摘要
目的探讨二期翻修术治疗髋关节假体周围感染的有效性和中期的临床效果。方法回顾性分析2014年3月—2016年9月因单侧髋关节假体周围感染在首都医科大学附属北京友谊医院骨科接受二期翻修术的31例患者的临床资料,其中男性13例,女性18例;年龄(67.5±7.8)岁,年龄范围52~79岁。所有患者接受二期翻修术,术前和术中取关节穿刺液、术中取感染软组织进行细菌培养以明确用药。一期取出假体、清创并使用抗生素间隔物,使用抗生素治疗感染8~12周,二期感染控制后行髋关节二期翻修术。比较所有患者术前、术后末次随访时的Harris髋关节评分、简明健康状况量表(SF-36)评分、白细胞计数、C反应蛋白和红细胞沉降率,并记录患者术后并发症情况。术后门诊随访30.1~59.3个月,术后3、6、12个月以及12个月后每12个月复查1次,随访截止时间为2019年4月。计量资料以均数±标准差(Mean±SD)表示,术前和术后末次随访比较采用t检验。结果除2例患者失访外,其余29例患者获得术后随访,术前Harris髋关节评分、SF-36评分、白细胞计数、C反应蛋白、红细胞沉降率分别是(39.4±5.6)分、(398.8±39.2)分、(12.5±0.6)×10^9/L、(63.3±10.1)mg/L和(83.7±12.5)mm/h,术后末次随访上述指标分别是(76.9±9.3)分、(649.3±67.5)分、(9.1±0.5)×10^9/L、(5.3±1.7)mg/L和(10.2±1.6)mm/h。术后末次随访的上述指标均明显优于术前,前后相比差异有统计学意义(P<0.05)。1例患者发生术后髋关节脱位,全身麻醉下经手法牵引复位治疗。2例患者在二期翻修术后8、15个月再次诊断为髋关节假体周围感染,取出假体后感染治愈,1例患者再次接受翻修手术,而另外1例患者因为身体原因不能接受手术。其余26例患者无并发症发生。结论二期翻修术不但可以有效地治疗感染而且还能够显著地恢复髋关节功能,这种手术治疗方法的中期临床疗效满意。
Objective To explore the validity of two-staged revision for hip periprosthetic joint injection and intermediate-term clinical effects. Methods The clinical data of 31 cases who were underwent two-staged revision for unilateral hip periprosthetic joint infection in Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University from March 2014 to September 2016 were analyzed retrospectively. There were 13 males and 18 females, aged (67.5±7.8) years, with an age range of 52-79 years. All patients underwent two-staged revision, taking preoperative and intraoperative joint puncture fluid, intraoperative infection of soft tissue for bacterial culture was to clear medication. In first stage, prosthesis removed, debridement performed and antibiotic spacer implanted were performed. Antibiotics were used for 8 to 12 weeks for infection. In second stage, total hip arthroplasty revision was performed while infection was controlled. Harris hip scores, Short form 36 health status scores (SF-36), white blood cell counts, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were compared between preoperative and postoperative follow-up in all patients, and postoperative complications were recorded. Postoperative outpatient follow-up was 30.1 to 59.3 months, and reviewed every 12 months after 3 months, 6 months, and 12 months. The follow\|up deadline was April 2019. Measurement data were expressed as mean±standard deviation (Mean±SD). The t test was used to compare the preoperative and postoperative follow-up. Results All 29 patients were followed up for follow-up except 2 patients were lost to follow-up. Preoperative Harris hip score, SF-36, white blood cell count, CRP and ESR were (39.4±5.6) scores,(398.8±39.2) scores,(12.5±0.6)×10^9/L,(63.3±10.1) mg/L and (83.7±12.5) mm/h, respectively. The last follow-up of the above indicators were (76.9±9.3) scores,(649.3±67.5) scores,(9.1±0.5)×10^9/L,(5.3±1.7) mg/L and (10.2±1.6) mm/h, respectively. The results of final followed-up were much better than the preoperative results and there were significant differences between postoperation and preoperation for all indexes. One patient developed postoperative hip dislocation and was treated with manual reduction under general anesthesia. The two patients were diagnosed hip periprosthetic joint infection of joint at 8 months and 15 months respectively after two-staged revision and treated by removing the hip prosthesis. One patient was performed revision again and the other was not performed any operation for poor health condition. The remaining 26 patients had no complications. Conclusions Two-staged revision for periprosthetic joint infection of hip joint can not only treat infection effectively but also can recover hip function significantly. The early and intermediate-term clinical effects of the surgical treatment is satisfied.
作者
马立峰
郭艾
李强
吴杰
刁乃成
杨波
喻飞
王迪凡
杨金江
Ma Lifeng;Guo Ai;Li Qiang;Wu Jie;Diao Naicheng;Yang Bo;Yu Fei;Wang Difan;Yang Jinjiang(Department of Orthopaedics,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)
出处
《国际外科学杂志》
2019年第7期459-464,共6页
International Journal of Surgery
关键词
关节成形术
置换
髋
假体相关感染
再手术
装置取出
治疗效果
Arthropalsty, replacement, hip
Prosthesis-related infections
Reoperation
Device removal
Treatment outcome
