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直接置换关节成形术在感染性全髋关节置换治疗中的作用有限。

Limited role of direct exchange arthroplasty in the treatment of infected total hip replacements.

作者信息

Jackson W O, Schmalzried T P

机构信息

Harbor-UCLA Medical Center, Torrance, CA, USA.

出版信息

Clin Orthop Relat Res. 2000 Dec(381):101-5. doi: 10.1097/00003086-200012000-00012.

Abstract

A literature review was performed to determine when direct exchange was most likely to be successful. Twelve reports provided outcome data on infected hip replacements treated with direct exchange. The average duration of followup was 4.8 years, but the range was broad (0.1-17.1 years). Of the 1,299 infected hip replacements treated with direct exchange, 1,077 (83%) were thought to be free of infection at the last followup. Antibiotic-impregnated bone cement was used in 1,282 of the cases (99%). There was wide variability in the duration of parenteral antibiotic therapy, ranging from just 24 hours to as many as 8 weeks. In some cases, no oral antibiotics ever were given, whereas in others, oral antibiotics were given for as many as 8 months after parenteral therapy. Factors associated with a successful direct exchange included: (1) absence of wound complications after the initial total hip replacement; (2) good general health of the patient; (3) methicillin-sensitive Staphylococcus epidermidis, Staphylococcus aureus, and Streptococcus species; and (4) an organism that was sensitive to the antibiotic mixed into the bone cement. Factors associated with failure included: (1) polymicrobial infection; (2) gram-negative organisms, especially Pseudomonas species; and (3) certain gram-positive organisms such as methicillin-resistant Staphylococcus epidermidis and Group D Streptococcus. Methicillin-resistant organisms have become more common. Many current revision surgical techniques use cementless implants. Fixation without any cement (no depot antibiotics) may be a contraindication to direct exchange. Additionally, there essentially are no data on the use of bone graft in association with direct exchange. For these reasons, the indications for direct exchange are limited.

摘要

进行了一项文献综述,以确定何时直接更换最有可能成功。十二份报告提供了采用直接更换治疗感染性髋关节置换术的结果数据。随访的平均时长为4.8年,但范围较广(0.1 - 17.1年)。在1299例采用直接更换治疗的感染性髋关节置换术中,1077例(83%)在最后一次随访时被认为已无感染。1282例(99%)病例使用了含抗生素骨水泥。肠外抗生素治疗的时长差异很大,从仅24小时到多达8周不等。在某些病例中,从未给予口服抗生素,而在其他病例中,肠外治疗后口服抗生素给予长达8个月。与直接更换成功相关的因素包括:(1)初次全髋关节置换术后无伤口并发症;(2)患者总体健康状况良好;(3)对甲氧西林敏感的表皮葡萄球菌、金黄色葡萄球菌和链球菌属;(4)对混入骨水泥中的抗生素敏感的微生物。与失败相关的因素包括:(1)多种微生物感染;(2)革兰氏阴性菌,尤其是假单胞菌属;(3)某些革兰氏阳性菌,如耐甲氧西林表皮葡萄球菌和D组链球菌。耐甲氧西林的微生物已变得更为常见。许多当前的翻修手术技术使用非骨水泥型植入物。无任何骨水泥固定(无长效抗生素)可能是直接更换的禁忌证。此外,基本上没有关于与直接更换联合使用骨移植的数据。由于这些原因,直接更换的适应证有限。

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