Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Division of Shoulder Surgery, Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
J Shoulder Elbow Surg. 2018 Nov;27(11):1996-2005. doi: 10.1016/j.jse.2018.03.031.
Our aim was to evaluate complications related to commercially available antibiotic cement spacers used in the treatment of shoulder infections.
We performed a retrospective review of commercially available antibiotic spacers implanted in 53 patients (60 spacers) between April 2009 and October 2017 as part of a 2-stage treatment plan for infection at the site of a shoulder arthroplasty (n = 39), other (non-arthroplasty) shoulder surgery (n = 8), or primary shoulder infection without previous surgery (n = 6). All patients were followed up from spacer placement to second-stage revision to shoulder arthroplasty. Ten patients retained the spacers and were followed up for a minimum of 1 year.
No complications were associated with implantation of the spacers. Of the 44 patients (50 spacers) who underwent a second-stage revision after a mean interval of 6 months (range, 2-18 months), 14 patients had 18 complications. Fourteen complications occurred between implantation and removal. The most common complication was bone erosion (6 in the glenoid and 2 in the humeral shaft). Other complications were fractures of the spacer (n = 4), spacer rotation (n = 3), and humeral fracture (n = 3). Two complications required reoperation. There were 4 spacer-related complications among the 10 patients who retained the implant (3 erosions of the humeral shaft and 1 humeral shaft fracture); none required reoperation or removal.
Complications related to antibiotic spacers are common especially between the first and second stage of revision, and awareness of these complications is important for the treating provider.
我们的目的是评估在治疗肩部感染时使用的市售抗生素水泥间隔物相关的并发症。
我们回顾性分析了 2009 年 4 月至 2017 年 10 月间使用市售抗生素间隔物治疗肩关节炎感染的 53 例患者（60 个间隔物），其中 39 例患者接受了肩关节炎置换术（关节成形术）部位的 2 期治疗方案（n=39），8 例患者接受了其他（非关节成形术）肩部手术，6 例患者接受了原发性肩部感染而无既往手术史。所有患者从间隔物植入到肩关节炎置换术的第 2 期修复都进行了随访。10 例患者保留了间隔物，并随访至少 1 年。
间隔物植入没有并发症。在 44 例患者（50 个间隔物）中，在平均 6 个月（2-18 个月）的间隔后进行了第 2 期修复，14 例患者发生了 18 种并发症。14 种并发症发生在植入和取出之间。最常见的并发症是骨侵蚀（6 例在关节盂，2 例在肱骨干）。其他并发症包括间隔物骨折（n=4）、间隔物旋转（n=3）和肱骨干骨折（n=3）。2 种并发症需要再次手术。在保留植入物的 10 例患者中，有 4 例出现与间隔物相关的并发症（3 例肱骨干侵蚀，1 例肱骨干骨折）；均无需再次手术或取出。
抗生素间隔物相关的并发症很常见，尤其是在第 1 期和第 2 期修复之间，因此治疗医生应了解这些并发症。
