| 人工髋关节置换术后感染的Ⅱ期翻修手术治疗 |
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投稿时间：2009-11-24
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| 作者 | Author | 单位 | Address | E-Mail |
| 董伊隆 |
DONG Yi-long |
温州医学院附属第三医院骨科，浙江 瑞安 325200 |
Department of Orthopaedics,the Third Affiliated Hospital of Wenzhou Medical College,Ruian 325200,Zhejiang,China |
dongyilongdel@sina.com |
| 杨国敬 |
YANG Guo-jing |
温州医学院附属第三医院骨科，浙江 瑞安 325200 |
Department of Orthopaedics,the Third Affiliated Hospital of Wenzhou Medical College,Ruian 325200,Zhejiang,China |
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| 林瑞新 |
LIN Rui-xin |
温州医学院附属第三医院骨科，浙江 瑞安 325200 |
Department of Orthopaedics,the Third Affiliated Hospital of Wenzhou Medical College,Ruian 325200,Zhejiang,China |
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| 期刊信息：《中国骨伤》2010年，第23卷，第3期，第194-196页 |
| DOI：10.3969/j.issn.1003-0034.2010.03.014 |
| 基金项目: |
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中文摘要:
目的：探讨Ⅱ期翻修手术治疗在全髋关节置换术后感染的疗效和临床体会，以及该技术的安全性和有效性。
方法：2006年1月至2009年3月，采用Ⅱ期翻修手术治疗17例(17髋)髋关节疾患，男7例，女10例；年龄43～75岁，平均58.5岁。17例患髋均有不同程度疼痛；关节液或假体周围组织细菌培养，11例阳性，6例阴性；术中所有患者假体周围组织病理检查发现急性炎症；8例出现与假体相通的窦道；15例血沉增快，15例C反应蛋白增高；17例X线片有骨融解、假体松动及骨膜反应等表现。所有病例采用Ⅱ期翻修手术治疗，Ⅰ期手术彻底清创，取出假体，以含万古霉素的骨水泥假体临时旷置，术后静脉输入抗生素4周后，改为口服抗生素6周。术后定期复查血沉和C 反应蛋白，待结果正常后再Ⅱ期行人工髋关节翻修术。结合手术前后患者髋关节Harris评分，对人工髋关节置换术后感染的Ⅱ期翻修手术治疗进行分析。
结果：所有患者获随访，时间12～35个月，平均19.5个月，术后X线片显示关节假体位置正确。Harris髋关节评分从术前平均(39.3±5.6) 分提高到末次随访的平均 (84.4±10.3)分(t= 15.86,P<0.01).
结论：Ⅱ期翻修手术治疗人工髋关节置换术后感染，具有疗效良好、安全可靠等优点，其为人工髋关节置换术后感染的治疗提供一种可靠的选择。 |
| 【关键词】关节成形术，置换，髋 感染 再手术 手术后并发症 |
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| Clinical study on second-stage revision in the postoperative infection after total hip replacement |
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ABSTRACT
Objective: To study the therapeutic effects and clinical experiences of second-stage revision in postoperative infection after total hip replacement and to explore its security and validity.
Methods: From January 2006 to March 2009,17 hips in 17 patients(7 males and 10 females,ranging in age from 43 to 75 years,with an average of 58.5 years) were treated with second-stage revision. All the patients suffered from different degrees of hip pain. In bacilliculture of Synovial fluid or peritonsillar tissue,11 patients showed positive Results and 6 patient negative. The intraoperative periprosthetic histopathological examination showed that all the patients had acute inflammation. Eight patients had sinus communicating with prosthesis;15 patients had increased ESR,and 15 patients had C reactive protein increased. All the patients had osteolysis,prosthesis loosening,and the performance of periosteal reaction in X-ray. All the patients were treated with second stage revision. In the first operation,thorough debridement was perfumed and the prosthesis was removed. Then the prosthesis of antibiotic-loaded acrylic cement was implanted. After giving antibiotics intravenously for 4 weeks,the antibiotics were taken orally for another six weeks. The ESR and C response protein were examined at regular time,and the second-stage revision surgery was perfumed when the ESR and C response protein were normal. The Harris score was used to evaluate therapeutic effects of second-stage revision surgery before and after treatment.
Results: All the patients were followed up with an average of 19.5 months,ranged from 12 to 35 months. No complications occurred. Postoperative X-ray showed prosthesis in the correct position. The Harris score increased from preoperative (39.3±5.6) to postoperative (84.4±10.3) (t=15.86,P<0.01).
Conclusion: The second-stage revision in postoperative infection after total hip replacement has a good efficacy,safety and reliability advantages. This technology provides an alternative in postoperative infection after total hip replacement. |
| KEY WORDS Arthroplasty,replacement,hip Infection Reoperation Postoperative complications |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 董伊隆,杨国敬,林瑞新.人工髋关节置换术后感染的Ⅱ期翻修手术治疗[J].中国骨伤,2010,23(3):194~196 |
| 英文格式: | DONG Yi-long,YANG Guo-jing,LIN Rui-xin.Clinical study on second-stage revision in the postoperative infection after total hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2010,23(3):194~196 |
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