Shen Hao, Wang Qiao-Jie, Zhang Xian-Long, Jiang Yao
Department of Orthopaedic Surgery, Division of Adult Reconstruction, Shanghai No. 6th Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, Republic of China.
Orthopedics. 2013 Apr;36(4):e404-8. doi: 10.3928/01477447-20130327-13.
Two-stage total hip arthroplasty (THA) is considered a safe choice for the treatment of primary infectious arthritis of the hip. In cases where the proximal portion of the femur is intact without infection, the use of a spacer with a femoral stem during the interim would disturb the normal femoral medullary cavity. The authors report the technical procedure and outcomes of cases using a novel medullary sparing, antibiotic-loaded hip spacer for the treatment of hip infections.Five consecutive patients (5 hips) with infectious arthritis of the hip were treated in a 2-stage approach using an intraoperatively made medullary-sparing hip spacer. During the first-stage THA, after thorough debridement of potentially infected and necrotic soft tissues, the spacer was inserted into the femoral neck and fixed without opening the femoral canal. Antibiotics were administered for at least 6 weeks and were continued until the infection was controlled clinically, after which the second-stage THA was completed.Infection was eradicated in all 5 hips. Average follow-up was 39.6 months (range, 30-59 months). At most recent follow-up, no recurrence of infection was observed. No specific complications were associated with the use of this novel spacer. Average Harris Hip Score improved from 35.2 (range, 28-43) before the first-stage THA to 61.6 (range, 54-71) between the 2 stages and to 93.6 (range, 89-99) at final follow-up. All patients ambulated with the aid of crutches during the interim period.
两阶段全髋关节置换术（THA）被认为是治疗髋关节原发性感染性关节炎的安全选择。在股骨近端未受感染且完整的情况下，在过渡期间使用带有股骨干的间隔物会干扰正常的股骨髓腔。作者报告了使用一种新型保留髓腔、负载抗生素的髋关节间隔物治疗髋关节感染的技术步骤和病例结果。
连续5例（5髋）髋关节感染性关节炎患者采用两阶段方法治疗，使用术中制作的保留髓腔的髋关节间隔物。在第一阶段THA中，在彻底清创潜在感染和坏死的软组织后，将间隔物插入股骨颈并固定，不打开股骨髓腔。抗生素至少使用6周，并持续使用至临床感染得到控制，之后完成第二阶段THA。
所有5髋的感染均被根除。平均随访39.6个月（范围30 - 59个月）。在最近一次随访时，未观察到感染复发。使用这种新型间隔物未出现特定并发症。平均Harris髋关节评分从第一阶段THA前的35.2（范围28 - 43）提高到两阶段之间的61.6（范围54 - 71），并在最终随访时提高到93.6（范围89 - 99）。所有患者在过渡期间借助拐杖行走。
