Vidal J, Salvan J, Orst G, Marnay T
Clinique de Chirurgie Orthopédique et Réparatrice, Hôpital Lapeyronie, Montpellier.
Rev Chir Orthop Reparatrice Appar Mot. 1988;74(3):223-31.
Sixty-seven cases of total arthroplasty of the hip in the presence of sepsis performed between 1974 and 1986 were reviewed. These prostheses were inserted in 57 cases to replace septic prostheses. Forty-six were infected total hip prostheses and 11 were infected head and neck replacement femoral prostheses. In 10 cases arthroplasty was performed for subacute septic arthritis, usually secondary to trauma. In seven cases, a simple revision of the prosthesis by excision and lavage of infected tissues was performed. In 51 cases, a total hip replacement arthroplasty was performed in one stage. When one of the components was not loose it was preserved; in 17 cases the femoral cement was retained and in six the acetabular cup was retained. In eight cases, the prosthesis was removed, excision of the tissues was made and a total hip arthroplasty inserted after a minimum interval of six months. As regards infection, success was achieved in 69 per cent of cases rising to 85 per cent after secondary removal of the prosthesis. In relation to function, a good or fair result was achieved in 72 per cent of cases. The results were favourable in 81 per cent of cases with complete exchange of prostheses and in 75 per cent with preservation of the femoral cement. Preservation of the acetabular cup was only successful in 40 per cent of cases. Accessory factors in the prognosis were the addition of a bone graft, which became incorporated in 29 cases out of 30 and the nature of the organism which was of no significance, except that staphylococcus epidermidis and Koch's bacillus proved to be more easy to treat.
回顾了1974年至1986年间进行的67例存在败血症情况下的全髋关节置换术。这些假体被植入57例患者体内以替换感染的假体。其中46例为感染的全髋关节假体，11例为感染的头颈置换股骨假体。10例患者因亚急性化脓性关节炎进行关节置换术，通常继发于创伤。7例患者通过切除和冲洗感染组织对假体进行了简单翻修。51例患者一期进行了全髋关节置换术。当其中一个组件未松动时予以保留；17例保留了股骨骨水泥，6例保留了髋臼杯。8例患者取出假体，切除组织，至少间隔6个月后植入全髋关节假体。在感染方面，69%的病例取得了成功，二次取出假体后成功率升至85%。在功能方面，72%的病例取得了良好或尚可的结果。假体完全更换的病例中81%结果良好，保留股骨骨水泥的病例中75%结果良好。保留髋臼杯的病例中只有40%获得成功。预后的辅助因素包括添加骨移植，30例中有29例骨移植成功融合，以及病原体的种类，病原体种类除表皮葡萄球菌和结核杆菌相对更易治疗外无显著意义。
