Department of Orthopaedic Surgery, University Hospital, Saarland University, Homburg/Saar, Germany.
Int J Med Sci. 2009 Sep 2;6(5):241-6. doi: 10.7150/ijms.6.241.
The aim of the present study was to evaluate the efficacy of the vacuum-assisted closure (V.A.C.) system in the treatment of early hip joint infections. 28 patients (11 m/17 f; mean age 71 y. [43-84]) with early hip joint infections have been treated by means of the V.A.C.-therapy. At least one surgical revision [1-7] has been unsuccessfully performed for infection treatment prior to V.A.C.-application. Pathogen organisms could have been isolated in 22/28 wounds. During revision, cup inlay and prosthesis head have been exchanged and 1-3 polyvinylalcohol sponges inserted into the wound cavity/ periprosthetically at an initial continuous pressure of 200 mm Hg. Postoperatively, a systemic antibiosis was given according to antibiogram. 48-72 h after surgery an alteration from haemorrhagic to serous fluid was observed in the V.A.C.-canister. Afterwards, the pressure was decreased to 150 mm Hg and remained at this level till sponge removal. After a mean period of 9 [3-16] days the inflammation parameters have been retrogressive and the sponges were removed. An infection eradication could be achieved in 26/28 cases. In the two remaining cases the infected prosthesis had to be explanted and a gentamicin-vancomycin-loaded spacer has been implanted, respectively. At a total mean follow-up of 36 [12-87] months no reinfection or infection persistence was observed. The V.A.C.-system can be a valuable contribution in the treatment of early joint infections when properly used. Indications should be early infections with well-maintained soft-tissues for retention of the negative atmospheric pressure.
本研究旨在评估真空辅助闭合（V.A.C.）系统在治疗早期髋关节感染中的疗效。28 例（11 男/17 女；平均年龄 71 岁[43-84]）早期髋关节感染患者接受 V.A.C.治疗。在应用 V.A.C.之前，至少有 1 次手术翻修[1-7]因感染治疗失败。22/28 例伤口可分离病原体。在翻修过程中，更换了杯衬和假体头，并在初始持续压力为 200mmHg 的情况下将 1-3 个聚乙烯醇海绵插入伤口腔/假体周围。术后根据药敏试验给予全身抗生素治疗。术后 48-72 小时，V.A.C.罐中观察到从血性到浆液性液体的变化。之后，压力降至 150mmHg，并保持在该水平直至海绵取出。平均 9[3-16]天后，炎症参数消退，海绵被取出。26/28 例感染得到清除。在另外 2 例中，感染的假体被取出，并分别植入了庆大霉素-万古霉素载药 spacer。在 36[12-87]个月的总平均随访中，未观察到再感染或感染持续存在。V.A.C.系统在适当使用时，可在治疗早期关节感染方面发挥重要作用。适应证应为早期感染，软组织保持良好，以维持负压。
