CAJ | 학술논문

目的探讨髋关节置换术后假体周围感染患者接受清创术、一期翻修术、二期翻修术及旷置术的临床效果.方法 1993年6月至2008年6月因髋关节置换术后假体周围感染接受手术治疗患者46例,男27例,女19例;年龄34～80岁,平均55.8岁.术前诊断感染的方法包括红细胞沉降率、C反应蛋白检查,放射性核素扫描,窦道分泌物及关节穿刺液培养.行保留假体的清创术7例,一期翻修术14例,二期翻修术21例,旷置术4例.术后观察伤口外观,随访时采用Harris评分对髋关节功能进行评估,行实验室检查确定感染控制情况.结果 46例假体周围感染患者中29例培养结果阳性,表皮葡萄球菌占感染病原体的首位(37.9%),其次为金黄色葡萄球菌(24.2%).35例获得随访,随访时间12～179个月,平均61.6个月.末次随访时Harris评分2～99分,平均76.5分.清创术后假体周围感染的控制率为16.7%,一期翻修术为54.5%,二期翻修术为93.3%,旷置术为100%.二期翻修术后假体周围骨折发生率13.3%,术后脱位率13.3%.11例感染复发,复发时间为感染治疗术后2～127个月,平均39.5个月.其中10例再次接受手术治疗,包括清创术1例、二期翻修术8例、旷置术1例.结论清创术与一期翻修术的选择应严格把握适应证.二期翻修术感染控制率高,但有发生假体周围骨折和脱位的风险.表皮葡萄球菌及金黄色葡萄球菌足关节感染的主要病原菌.
목적 탐토관관절치환술후가체주위감염환자접수청창술、일기번수술、이기번수술급광치술적림상효과.방법 1993년6월지2008년6월인관관절치환술후가체주위감염접수수술치료환자46례,남27례,녀19례;년령34～80세,평균55.8세.술전진단감염적방법포괄홍세포침강솔、C반응단백검사,방사성핵소소묘,두도분비물급관절천자액배양.행보류가체적청창술7례,일기번수술14례,이기번수술21례,광치술4례.술후관찰상구외관,수방시채용Harris평분대관관절공능진행평고,행실험실검사학정감염공제정황.결과 46례가체주위감염환자중29례배양결과 양성,표피포도구균점감염병원체적수위(37.9%),기차위금황색포도구균(24.2%).35례획득수방,수방시간12～179개월,평균61.6개월.말차수방시Harris평분2～99분,평균76.5분.청창술후가체주위감염적공제솔위16.7%,일기번수술위54.5%,이기번수술위93.3%,광치술위100%.이기번수술후가체주위골절발생솔13.3%,술후탈위솔13.3%.11례감염복발,복발시간위감염치료술후2～127개월,평균39.5개월.기중10례재차접수수술치료,포괄청창술1례、이기번수술8례、광치술1례.결론 청창술여일기번수술적선택응엄격파악괄응증.이기번수술감염공제솔고,단유발생가체주위골절화탈위적풍험.표피포도구균급금황색포도구균족관절감염적주요병원균.
Objective To evaluate the clinical outcome of debridement with Prosthesis retention, one-stage, two-stage revision, and resection arthroplasty for the infected hip replacement. Methods Forty-six patients admitted for infected total hip arthroplasty from June 1993 to June 2008 were reviewed. There were 27 males and 19 females, with an average age of 55.8 years. Preoperative investigations for infection included ESR, CRP, ECT and joint fluid culture from sinus or aspiration. Patients were treated with debride-ment with prosthesis retention, one-stage revision, two-stage revision, or resection arthroplasty to eradicate the infection. For infection evaluation, wound healing, Harris score, and laboratory tests were collected. Re-suits There was evidence of deep infection in infected hip prostheses in 29 patients whose joint fluid cul-ture revealed Staphylococcus epidermidis (37.9%) remained in the first place, following by Staphylococcus aureus (24.2%). The mean duration of follow-up was 61.6 months (range 12 to 179 months). The Harris score at final follow-up was 76.5 (range 2 to 99). Eleven patients suffered a relapse occurred at a mean time of 39.5 months (2 to 127 months) when primary infections were diagnosed. The infection control rates of debridement with prosthesis retention, one-stage revision and two-stage revision were 16.7%, 54.5% and 93.3% respectively. The rate of peri-prosthetie fracture and dislocation were equally 13.3% after two-stage revision arthroplasty. No recurrent infection occurred after resection arthroplasties were performaneed. Con-clusion Debridement with prosthesis retention and one-stage revision can he successful in appropriately se-lected patients. Two-stage revision of an infected hip arthroplasty can achieve a high success rate with the risk of peri-prosthetie fracture and dislocation. Staphylococcus epidermidis and Staphylococcus aureus are the causative agents of the infected hip arthroplasty.