Mitchell Philip A, Masri Bassam A, Garbuz Donald S, Greidanus Nelson V, Duncan Clive P
Division of Reconstructive Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
Instr Course Lect. 2003;52:323-30.
Eradication of chronic infection complicating total hip arthroplasty requires removal of all infected, devitalized and foreign tissue, including the arthroplasty components. Reimplantation into a sterile bed is the goal of treatment in most patients and successful reimplantation yields better functional results than excision arthroplasty. Reimplantation may be performed at the same stage as débridement as part of a single-stage procedure, using cemented components with antibiotic-loaded cement. Alternatively, a two-stage procedure may be performed so that the débridement and reimplantation are separated by a period of antibiotic delivery, both locally and systemically. The results of these treatment regimens and the rationale for cementless reconstruction at the second stage of a two-stage treatment protocol are important considerations in the treatment of periprosthetic infection.
根除全髋关节置换术后并发的慢性感染需要清除所有感染、失活及外来组织，包括关节置换部件。对大多数患者而言，植入无菌组织床是治疗目标，成功再植入比关节切除成形术能带来更好的功能结果。再植入可与清创术在同一阶段进行，作为单阶段手术的一部分，使用含抗生素骨水泥的骨水泥型部件。或者，可采用两阶段手术，使清创术和再植入术之间间隔一段局部和全身抗生素给药期。这些治疗方案的结果以及两阶段治疗方案第二阶段非骨水泥重建的原理是假体周围感染治疗中的重要考量因素。
