Wang Long, Hu Yihe, Dai Zixun, Zhou Jialin, Li Mingqing, Li Kanghua
Department of Orthopedics, Xiangya Hospital, Central South University, Changsha Hunan 410008, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2011 Jun;25(6):646-9.
To evaluate the mid-term effectiveness of two-stage hip prosthesis revision in the treatment of infection after hip arthroplasty.
Between April 2002 and November 2006, 12 cases of infection after hip arthroplasty were treated. There were 5 males and 7 females, aged from 47 to 72 years (mean, 59.8 years). The femoral head arthroplasty was performed in 2 cases and total hip arthroplasty in 10 cases. Infection occurred 1 to 67 months after arthroplasty. According to the Segawa classification criteria, infections included type 2 in 1 case, type 3 in 2 cases, and type 4 in 9 cases. The preoperative Harris score was 36.7 +/- 6.1. Nine cases had elevated C reactive protein and 10 cases had elevated erythrocyte sedimentation rate. The results of bacterial culture were positive in 8 cases and negative in 4 cases. After the removal of the infected prosthesis and thorough debridement, antibiotic-loaded cement spacers or infected therapeutic temporary prosthesis were used as placeholders, and then the anti-infection treatments were given after operations; two-stage hip prosthesis revisions were performed 3 to 10 months after debridement.
In 1 patient who failed to control infection after debridement, infection was controlled after the second debridement and the antibiotic-loaded cement spacer as placeholder. Other patients achieved healing of incision by first intention, and no complication such as deep venous thrombosis and nerve injury occurred. All patients were followed up 3 to 8 years after revision (mean, 5.4 years). During the follow-up, no infection recurrence and joint dislocation occurred. Dull pain was present in 2 cases during activity and mild claudication in 3 cases at last follow-up. The Harris score was 81.6 +/- 4.5, showing significant difference (t = 52.696, P = 0.000) when compared with preoperative score. The X-ray films showed that no prosthesis loosening and obvious subsidence were observed, and bone graft healed.
The two-stage hip prosthesis revision has good infection control rate and mid-term effectiveness in treatment of infection after hip arthroplasty.
评估两期髋关节假体翻修术治疗髋关节置换术后感染的中期疗效。
2002年4月至2006年11月，治疗12例髋关节置换术后感染患者。其中男性5例，女性7例，年龄47至72岁（平均59.8岁）。股骨头置换术2例，全髋关节置换术10例。感染发生在置换术后1至67个月。根据泽川分类标准，1型感染1例，3型感染2例，4型感染9例。术前Harris评分为36.7±6.1。9例C反应蛋白升高，10例红细胞沉降率升高。细菌培养结果8例阳性，4例阴性。去除感染假体并彻底清创后，使用载抗生素骨水泥间隔物或感染性治疗临时假体作为占位器，术后给予抗感染治疗；清创后3至10个月行两期髋关节假体翻修术。
1例清创后感染未控制患者，二次清创并使用载抗生素骨水泥间隔物作为占位器后感染得到控制。其他患者切口一期愈合，未发生深静脉血栓、神经损伤等并发症。所有患者翻修后随访3至8年（平均5.4年）。随访期间，无感染复发及关节脱位发生。末次随访时，2例活动时有隐痛，3例有轻度跛行。Harris评分为81.6±4.5，与术前评分比较差异有统计学意义（t = 52.696，P = 0.000）。X线片显示未观察到假体松动及明显下沉，植骨愈合。
两期髋关节假体翻修术治疗髋关节置换术后感染具有良好的感染控制率及中期疗效。
