Dairaku Katsuyuki, Takagi Michiaki, Kawaji Hiroyuki, Sasaki Kan, Ishii Masaji, Ogino Toshihiko
Department of Orthopaedic Surgery, Saiseikai Yamagata Saisei Hospital, 79-1 Oki-machi, Yamagata 990-8545, Japan.
J Orthop Sci. 2009 Nov;14(6):704-10. doi: 10.1007/s00776-009-1406-z. Epub 2009 Dec 8.
Periprosthetic infection is one of the serious complications after total hip arthroplasty (THA). This study analyzed the perioperative and postoperative status of patients who underwent antibiotics-impregnated cement spacer technique in the first step of the two-stage revision.
Ten joints of the nine patients (mean age, 65 years; seven women, two men) received two-stage revision as a result of infection that appeared after primary THAs in seven joints, aseptic revision in one, and recurrent type in two. An antibiotics-impregnated cement spacer made by a mold system was applied in the femoral side of all joints. An acetabular spacer was made by hand using a cup gauge in eight joints with extensive tissue loss.
The change of leg length after the first stage was -2.2 mm, and range of hip flexion was 72 degrees on average, respectively. Patients could walk with crutches after the first stage, except one patient with simultaneous infections of both hips and one with fracture of the cement spacer. One fracture of femoral cement spacer, and one dislocation of femoral spacer accompanied by fracture of acetabular cement spacer and curable recurrent infection, were found. In all cases of the second-stage procedure, the acetabular side was reconstructed with allogeneic bone graft with cross plate and that of the femur was by impaction bone grafting method. In the latest follow-up, reconstructed implants were stable. Seven patients could walk without any supportive devices and two could walk with the support of a T-cane.
An antibiotics-impregnated cement spacer in the first step of the two-stage revision was effective not only to compensate tissue loss after removal of the implants and to minimize discrepancy of leg length, but also to contribute to improvement of perioperative and postoperative daily activities of the patient's life as well as treatment of the infection.
人工关节周围感染是全髋关节置换术（THA）后严重的并发症之一。本研究分析了在两阶段翻修术第一步采用抗生素骨水泥间隔物技术的患者围手术期及术后状况。
9例患者的10个关节（平均年龄65岁；7例女性，2例男性）接受了两阶段翻修术，其中7个关节是初次全髋关节置换术后出现感染，1个是无菌性翻修，2个是复发性感染。所有关节的股骨侧均应用了模具系统制作的抗生素骨水泥间隔物。8个存在广泛组织缺损的关节，髋臼侧的间隔物是使用髋臼测量器手工制作的。
第一阶段术后下肢长度变化为-2.2毫米，平均髋关节屈曲范围为72度。第一阶段术后，除1例双侧髋关节同时感染的患者和1例骨水泥间隔物骨折的患者外，其他患者均可借助拐杖行走。发现1例股骨骨水泥间隔物骨折，1例股骨间隔物脱位并伴有髋臼骨水泥间隔物骨折及可治愈的复发性感染。在所有二期手术病例中，髋臼侧采用异体骨移植加交叉钢板重建，股骨侧采用打压植骨法重建。在最近一次随访中，重建植入物稳定。7例患者无需任何辅助装置即可行走，2例患者需借助丁字拐行走。
两阶段翻修术第一步使用抗生素骨水泥间隔物不仅能有效弥补植入物取出后的组织缺损并使下肢长度差异最小化，还有助于改善患者围手术期及术后的日常生活活动以及感染的治疗。
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