Choa R, Gundle R, Critchley P, Giele H
Nuffield Orthopaedic Centre, Windmill Road, Headington, Oxford OX3 7LD, UK.
J Bone Joint Surg Br. 2011 Jun;93(6):751-4. doi: 10.1302/0301-620X.93B6.25726.
Deep prosthetic joint infection remains an uncommon but serious complication of total hip replacement. We reviewed 24 patients with recalcitrant hip wounds following infected total hip replacement treated with either pedicled rectus femoris or vastus lateralis muscle flaps between 1998 and 2009. The mean age of the patients was 67.4 years (42 to 86) with ten men and 14 women. There had been a mean of four (1 to 8) previous attempts to close the wound. A total of 20 rectus femoris and five vastus lateralis flaps were used, with one of each type of flap failing and requiring further reconstruction. All patients had positive microbiology. At a mean follow-up of 47 months (9 to 128), 22 patients had a healed wound and two had a persistent sinus. The prosthesis had been retained in five patients. In the remainder it had been removed, and subsequently re-implanted in nine patients. Six patients continued to take antibiotics at final follow-up. This series demonstrates the effectiveness of pedicled muscle flaps in healing these infected wounds. The high number of previous debridements suggests that these flaps could have been used earlier.
深部人工关节感染仍然是全髋关节置换术一种少见但严重的并发症。我们回顾了1998年至2009年间24例在感染性全髋关节置换术后出现顽固性髋部伤口的患者，这些患者接受了带蒂股直肌或股外侧肌肌瓣治疗。患者的平均年龄为67.4岁（42至86岁），男性10例，女性14例。此前平均有4次（1至8次）尝试闭合伤口。共使用了20个股直肌肌瓣和5个股外侧肌肌瓣，每种肌瓣各有1个失败并需要进一步重建。所有患者微生物学检查均呈阳性。平均随访47个月（9至128个月）时，22例患者伤口愈合，2例有持续窦道。5例患者保留了假体。其余患者的假体已取出，随后9例患者重新植入。6例患者在末次随访时仍在服用抗生素。本系列病例证明了带蒂肌瓣在愈合这些感染伤口方面的有效性。此前大量的清创术表明这些肌瓣本可以更早使用。
