Lee Sung Hyun, Kim Se Jin, Kook Seng Hwan, Kim Jeong Woo
Department of Orthopedic Surgery, School of Medicine, Wonkwang University Hospital, 895 Muwang-ro, Iksan, Republic of Korea.
Int Orthop. 2018 Apr;42(4):867-874. doi: 10.1007/s00264-017-3699-4. Epub 2017 Dec 2.
This study aimed to evaluate the clinical outcomes and persistent infection rate of two-stage revision of infected shoulder arthroplasty.
We enrolled 12 patients who developed an infection after undergoing shoulder arthroplasty between January 2009 and January 2014. They underwent a two-stage revision with PROSTALAC implantation and shoulder re-implantation in the first- and second-stage surgery, respectively. The mean follow-up period was 40.88 months (range, 36-52 months). After the second-stage re-implantation, clinical scores, erythrocyte sedimentation rate, as well as C-reactive protein level were evaluated, and the presence of re-infection and complications were analyzed.
Infection was improved in all the cases after PROSTALAC insertion. The mean range of motion of forward elevation, external rotation, and internal rotation at the final follow-up after the second-stage re-implantation were 81.67°, 40.42°, and 16.67° (vertebral level), respectively. The mean visual analog scale score improved from 7.08 points before surgery to 2.33 points after surgery. The Modified American Shoulder and Elbow Surgeons score improved from 32.25 before surgery to 64.17 after surgery (P < 0.05). The Constant shoulder score also improved from 30.92 before surgery to 66.08 after surgery (P < 0.05). Infection had not recurred until the final follow-up. However, dislocation and separation of components were found in two patients who needed a structural allograft because of segmental bone defects.
Using PROSTALAC in two-stage revision arthroplasty is effective for infection control and produced good clinical outcomes after second-stage shoulder re-implantation. However, cases involving segmental bone defects require additional precautions in maintaining the appropriate tension and height to prevent complications.
本研究旨在评估感染性肩关节置换二期翻修的临床疗效及持续感染率。
我们纳入了2009年1月至2014年1月期间接受肩关节置换术后发生感染的12例患者。他们分别在一期和二期手术中接受了带抗生素间隔物（PROSTALAC）植入和肩关节再植入的二期翻修。平均随访时间为40.88个月（范围36 - 52个月）。二期再植入后，评估临床评分、红细胞沉降率以及C反应蛋白水平，并分析再感染和并发症的发生情况。
植入PROSTALAC后所有病例的感染均得到改善。二期再植入后最终随访时前屈、外旋和内旋的平均活动范围分别为81.67°、40.42°和16.67°（椎体水平）。视觉模拟评分平均从术前的7.08分改善至术后的2.33分。美国肩肘外科医师协会改良评分从术前的32.25分提高至术后的64.17分（P < 0.05）。Constant肩关节评分也从术前的30.92分提高至术后的66.08分（P < 0.05）。直至最终随访时感染均未复发。然而，两名因节段性骨缺损需要结构性同种异体骨移植的患者出现了假体脱位和组件分离。
在二期翻修关节成形术中使用PROSTALAC对控制感染有效，且在二期肩关节再植入后产生了良好的临床疗效。然而，涉及节段性骨缺损病例在维持适当张力和高度以预防并发症方面需要额外的注意。
