Hsieh Pang-Hsin, Chang Yu-Han, Chen Shih-Hao, Shih Chun-Hsiung
Department of Orthopaedics, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Kweishian, Taoyuan, Taiwan.
Int Orthop. 2006 Aug;30(4):228-32. doi: 10.1007/s00264-005-0059-6. Epub 2006 May 4.
Deep hip infection is a rare complication of intertrochanteric fractures and an optimal treatment has not yet been reported. Twenty-seven patients who contracted deep hip sepsis following the failed primary treatment of an intertrochanteric fracture were treated with two-stage hip arthroplasty. Antibiotic-impregnated cement beads were implanted following resection arthroplasty in the first 15 patients, and a temporary cement spacer prosthesis was used in the other 12 hips. There was only one recurrence of infection at an average follow-up of 4.8 years. Complications included non-union of the greater trochanter in four patients, intraoperative femoral fracture in two and fracture of the cement prosthesis in one. The use of an interim spacer was associated with better hip function in the interim period; a decreased operative time and less blood loss at the time of arthroplasty; and a higher hip score at final follow-up. Staged arthroplasty is an effective salvage procedure for deep hip infection after the failed treatment of an intertrochanteric fracture. The use of a temporary spacer maintains hip function between stages, makes arthroplasty less complicated, and improves the clinical outcome.
深部髋部感染是股骨转子间骨折罕见的并发症，目前尚未报道最佳治疗方法。27例股骨转子间骨折初次治疗失败后发生深部髋部脓毒症的患者接受了两期髋关节置换术。前15例患者在切除关节成形术后植入了抗生素骨水泥珠，另外12例髋关节使用了临时骨水泥间隔假体。平均随访4.8年时仅1例感染复发。并发症包括4例大转子不愈合、2例术中股骨骨折和1例骨水泥假体骨折。使用临时间隔物在过渡期髋关节功能更好；关节置换术时手术时间缩短、失血减少；最终随访时髋关节评分更高。分期关节置换术是股骨转子间骨折治疗失败后深部髋部感染的有效挽救手术。使用临时间隔物可在两期手术之间维持髋关节功能，使关节置换术更简单，并改善临床结果。
