| 术中自制抗生素骨水泥占位器在治疗髋关节置换术后感染的并发症研究 |
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Received:January 20, 2017
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| 作者 | Author | 单位 | Unit | E-Mail |
| 杜银桥 |
DU Yin-qiao |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 周勇刚 |
ZHOU Yong-gang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
zhouyg@263.net |
| 郝立波 |
HAO Li-bo |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 吴文明 |
WU Wen-ming |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 马海洋 |
MA Hai-yang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 郑充 |
ZHENG Chong |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 朴尚 |
PIAO Shang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 高志森 |
GAO Zhi-sen |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 孙菁阳 |
SUN Jing-yang |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 王森 |
WANG Sen |
中国人民解放军总医院骨科, 北京 100853 |
Department of Orthopaedics, Chinese PLA General Hospital, Beijing 100853, China |
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| 期刊信息：《中国骨伤》2017年30卷，第5期，第436-440页 |
| DOI：10.3969/j.issn.1003-0034.2017.05.009 |
| 基金项目:北京市自然科学基金（编号；7152139） |
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目的：研究术中自制抗生素骨水泥占位器在治疗髋关节置换术后感染的控制率及其并发症。
方法：对2006年1月至2016年7月解放军总医院骨关节科髋关节置换术后感染行占位器植入患者265例（266髋）进行回顾性研究，其中男143例（144髋），女122例（122髋）.占位器均利用自行设计的压模器术中制作，全部占位器均加入万古霉素，同时根据细菌药敏结果加入另外一种抗生素。记录是否行大粗隆延长截骨术（ETO）取出感染假体、占位器并发症（断裂和脱位）的发生率、Harris评分和感染的控制率。
结果：占位器植入时患者的平均年龄（57.4±14.2）岁。39例（14.7%）行ETO取出感染假体。38例（14.3%）出现了占位器的并发症，其中28例（10.5%）出现了占位器断裂，10例（3.8%）出现了占位器脱位。平均随访时间（83.4±14.6）个月。Harris评分从术前的47.56±14.23上升到末次随访的86.43±12.84（P<0.05）.256例（96.6%）植入占位器术后感染得到了有效控制。Ⅱ期翻修术后到末次随访，4例患者再次出现感染，并再次行Ⅱ期翻修，感染得到控制。感染总的控制率为95.1%（252/265）.
结论：术中自制抗生素骨水泥占位器控制髋关节置换术后感染具有显着效果，占位器并发症发生率较低，占位器结合钢丝、钛缆、捆绑带、异体骨板及螺钉不影响感染的控制。 |
| [关键词]:关节成形术，置换，髋 感染 占位器 Ⅱ期翻修 |
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| Mechanical complications with self-made,antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement |
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Abstract:
Objective: To study the complications and efficacy of self-made,antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement.
Methods: Between January 2006 and July 2016,265 patients (266 hips) received a self-made,antibiotic-loaded cement articulating spacer as part of a two-stage protocol. Among those patients,there were 143 males(144 hips) and 122 females(122 hips). The cement articulating spacers with vancomycin and two Steinman pins were made by a self-made mold system. Meanwhile,another antibiotic was added to the spacers according to the drug sensitivity test. Record if the infected prosthesis was removed,related complication with spacer(breakage and dislocation),Harris score,and control rate of infection.
Results: The mean age of two-stage revision operation was(57.4±14.2) years. Thirty-nine patients(14.7%) used extended trochanteric osteotomy(ETO) to remove the infected prosthesis. And 38 patients occurred mentioned complications(14.3%). Spacer breakage occurred in 28 cases(10.5%) and dislocation occurred in 10 cases(3.8%). The mean follow-up time was(83.4±14.6) months. The Harris hip score was from 47.56±14.23 preoperatively to 86.43±12.84 at final follow-up(P<0.05). The infection of 256 cases(96.6%) got control after revision operation. However,during postoperative follow-up,4 cases occurred re-infection,and they were reoperated,and the infections obtained effective control after the operation. Thus total infection control rate was 95.1%(252/265).
Conclusion: Antibiotic-loaded cement articulating spacer made by a self-made mold system is effective in controling infection caused by hip replacement. Related complication is less with spacer by a mould enclosing two Steinman pins. Using metallic internal fixation or allograft bone combined with spacer does not affect infection control. |
| KEYWORDS:Arthroplasty,replacement,hip Infection Spacer Two-stage revision |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 杜银桥,周勇刚,郝立波,吴文明,马海洋,郑充,朴尚,高志森,孙菁阳,王森.术中自制抗生素骨水泥占位器在治疗髋关节置换术后感染的并发症研究[J].中国骨伤,2017,30(5):436~440 |
| 英文格式: | DU Yin-qiao,ZHOU Yong-gang,HAO Li-bo,WU Wen-ming,MA Hai-yang,ZHENG Chong,PIAO Shang,GAO Zhi-sen,SUN Jing-yang,WANG Sen.Mechanical complications with self-made,antibiotic-loaded cement articulating spacers in the treatment of the infected hip replacement[J].zhongguo gu shang / China J Orthop Trauma ,2017,30(5):436~440 |
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