Padegimas Eric M, Narzikul Alexia, Lawrence Cassandra, Hendy Benjamin A, Abboud Joseph A, Ramsey Matthew L, Williams Gerald R, Namdari Surena
Department of Orthopaedic Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Department of Orthopaedic Surgery, The Rothman Institute, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Clin Orthop Surg. 2017 Dec;9(4):489-496. doi: 10.4055/cios.2017.9.4.489. Epub 2017 Nov 10.
Antibiotic spacers in shoulder periprosthetic joint infection deliver antibiotics locally and provide temporary stability. The purpose of this study was to evaluate differences between stemmed and stemless spacers.
All spacers placed from 2011 to 2013 were identified. Stemless spacers were made by creating a spherical ball of cement placed in the joint space. Stemmed spacers had some portion in the humeral canal. Operative time, complications, reimplantation, reinfection, and range of motion were analyzed.
There were 37 spacers placed: 22 were stemless and 15 were stemmed. The stemless spacer population was older (70.9 ± 7.8 years vs. 62.8 ± 8.4 years, = 0.006). The groups had a similar percentage of each gender (stemless group, 45% male vs. stemmed group, 40% male; = 0.742), body mass index (stemless group, 29.1 ± 6.4 kg/m vs. stemmed group, 31.5 ± 8.3 kg/m; = 0.354) and Charlson Comorbidity Index (stemless group, 4.2 ± 1.2 vs. stemmed group, 4.2 ± 1.7; = 0.958). Operative time was similar (stemless group, 127.5 ± 37.1 minutes vs. stemmed group, 130.5 ± 39.4 minutes). Two stemless group patients had self-resolving radial nerve palsies. Within the stemless group, 15 of 22 (68.2%) underwent reimplantation with 14 of 15 having forward elevation of 109° ± 23°. Within the stemmed group, 12 of 15 (80.0%, = 0.427) underwent reimplantation with 8 of 12 having forward elevation of 94° ± 43° (range, 30° to 150°; = 0.300). Two stemmed group patients had axillary nerve palsies, one of which self-resolved but the other did not. One patient sustained dislocation of reverse shoulder arthroplasty after reimplantation. One stemless group patient required an open reduction and glenosphere exchange of dislocated reverse shoulder arthroplasty at 6 weeks after reimplantation.
Stemmed and stemless spacers had similar clinical outcomes. When analyzing all antibiotic spacers, over 70% were converted to revision arthroplasties. The results of this study do not suggest superiority of either stemmed or stemless antibiotic spacers.
肩部人工关节周围感染中的抗生素间隔物可局部输送抗生素并提供临时稳定性。本研究的目的是评估有柄和无柄间隔物之间的差异。
确定了2011年至2013年植入的所有间隔物。无柄间隔物是通过在关节间隙中制作一个水泥球制成的。有柄间隔物在肱骨髓腔内有一定部分。分析了手术时间、并发症、再次植入、再感染和活动范围。
共植入37个间隔物：22个无柄，15个有柄。无柄间隔物组患者年龄更大（70.9±7.8岁对62.8±8.4岁，P = 0.006）。两组的男女比例相似（无柄组45%为男性，有柄组40%为男性；P = 0.742），体重指数相似（无柄组29.1±6.4kg/m²对有柄组31.5±8.3kg/m²；P = 0.354），Charlson合并症指数相似（无柄组4.2±1.2对有柄组4.2±1.7；P = 0.958）。手术时间相似（无柄组127.5±37.1分钟对有柄组130.5±39.4分钟）。无柄组有2例患者出现自行缓解的桡神经麻痹。在无柄组中，22例中有15例（68.2%）接受了再次植入，其中15例中有14例前屈抬高角度为109°±23°。在有柄组中，15例中有12例（80.0%，P = 0.427）接受了再次植入，其中12例中有8例前屈抬高角度为94°±43°（范围30°至150°；P = 0.300）。有柄组有2例患者出现腋神经麻痹，其中1例自行缓解，另1例未缓解。1例患者在再次植入后发生反肩关节置换脱位。1例无柄组患者在再次植入后6周需要对脱位的反肩关节置换进行切开复位和球窝关节置换。
有柄和无柄间隔物的临床结果相似。在分析所有抗生素间隔物时，超过70%最终进行了关节翻修手术。本研究结果并不表明有柄或无柄抗生素间隔物具有优越性。
