中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2009年
8期
749-753
,共5页
李玉军%黄德勇%张洪%周乙雄%殷建华%徐辉%李为%郭晓忠%张春雨%周一新%黄野
李玉軍%黃德勇%張洪%週乙雄%慇建華%徐輝%李為%郭曉忠%張春雨%週一新%黃野
리옥군%황덕용%장홍%주을웅%은건화%서휘%리위%곽효충%장춘우%주일신%황야
关节成形术,置换,髋%感染%再手术
關節成形術,置換,髖%感染%再手術
관절성형술,치환,관%감염%재수술
Arthroplasty,replacement,hip%Infection%Reoperation
目的 探讨骨水泥间隔物在人工髋关节置换术后感染中的应用方法 及作用.方法 1999年1月至2007年12月收治单侧人工髋关节置换术后感染者36例,男20例,女16例;假体取出时年龄34～80岁,平均52岁.置换术后至出现感染的时间为2周～19年.34例在一期手术中取出全部假体,2例分次取出假体.骨水泥间隔物内加入5%～10%的万古霉素.对有脓性分泌物者留置出入管进行灌洗,一般维持3～7 d,术后1周可下地活动,但患肢至少免负重2个月.术后常规静脉使用万古霉素,或根据细菌培养结果 选用敏感抗生素,2周后改敏感抗生素或口服利福平巩固4～8周.结果 34例患者的感染在术后3～19个月内得到有效控制;其中2例间隔物折断(支架为髓内钉),1例间隔物脱位;2例患者(以斯氏针和原股骨假体为支架者各1例)在感染控制后拒绝翻修.2例感染持续存在,1例行间隔物取出、股骨上端旷置,术后感染获得控制;1例行间隔物取出、股骨上端旷置,术后因并发症死亡.使用间隔物后的感染治愈率为94.7%.结论 骨水泥间隔物可通过局部缓慢释放高浓度抗生素明显提高感染的治愈率,同时可维持关节的稳定性,限制瘢痕形成,避免下肢不等长,便于再次进行关节置换.
目的 探討骨水泥間隔物在人工髖關節置換術後感染中的應用方法 及作用.方法 1999年1月至2007年12月收治單側人工髖關節置換術後感染者36例,男20例,女16例;假體取齣時年齡34～80歲,平均52歲.置換術後至齣現感染的時間為2週～19年.34例在一期手術中取齣全部假體,2例分次取齣假體.骨水泥間隔物內加入5%～10%的萬古黴素.對有膿性分泌物者留置齣入管進行灌洗,一般維持3～7 d,術後1週可下地活動,但患肢至少免負重2箇月.術後常規靜脈使用萬古黴素,或根據細菌培養結果 選用敏感抗生素,2週後改敏感抗生素或口服利福平鞏固4～8週.結果 34例患者的感染在術後3～19箇月內得到有效控製;其中2例間隔物摺斷(支架為髓內釘),1例間隔物脫位;2例患者(以斯氏針和原股骨假體為支架者各1例)在感染控製後拒絕翻脩.2例感染持續存在,1例行間隔物取齣、股骨上耑曠置,術後感染穫得控製;1例行間隔物取齣、股骨上耑曠置,術後因併髮癥死亡.使用間隔物後的感染治愈率為94.7%.結論 骨水泥間隔物可通過跼部緩慢釋放高濃度抗生素明顯提高感染的治愈率,同時可維持關節的穩定性,限製瘢痕形成,避免下肢不等長,便于再次進行關節置換.
목적 탐토골수니간격물재인공관관절치환술후감염중적응용방법 급작용.방법 1999년1월지2007년12월수치단측인공관관절치환술후감염자36례,남20례,녀16례;가체취출시년령34～80세,평균52세.치환술후지출현감염적시간위2주～19년.34례재일기수술중취출전부가체,2례분차취출가체.골수니간격물내가입5%～10%적만고매소.대유농성분비물자류치출입관진행관세,일반유지3～7 d,술후1주가하지활동,단환지지소면부중2개월.술후상규정맥사용만고매소,혹근거세균배양결과 선용민감항생소,2주후개민감항생소혹구복리복평공고4～8주.결과 34례환자적감염재술후3～19개월내득도유효공제;기중2례간격물절단(지가위수내정),1례간격물탈위;2례환자(이사씨침화원고골가체위지가자각1례)재감염공제후거절번수.2례감염지속존재,1례행간격물취출、고골상단광치,술후감염획득공제;1례행간격물취출、고골상단광치,술후인병발증사망.사용간격물후적감염치유솔위94.7%.결론 골수니간격물가통과국부완만석방고농도항생소명현제고감염적치유솔,동시가유지관절적은정성,한제반흔형성,피면하지불등장,편우재차진행관절치환.
Objective To study the application and effects of bone cement spacer on the treatment of infections following artificial hip replacement. Methods Among the 36 eases of infections following uni-lateral hip replacement, 20 patients were males and 16 were females. The average age of prosthesis removing was 52 years. The time interval between the hip replacement and the infection varied form 2 weeks to 19 years. 34 eases took out the total hip prosthesis in the first-stage procedure; 1 case took out the acetabular 5 month later due to re-infection; 1 case took out the total hip prosthesis 1 month later due to re-infection. The spacers were made from bone cement mixed by 5％-10％ vancomycin, implanted the femoral medullary cav-ity. Lavage the indwelling tubes if there were more purulent secretions. Patients were given routine intra-venous vancomyein, twice a day, or sensitive antibiotics according to the bacterial culture Results . Two weeks later, the medication was changed to other sensitive antibiotics or oral Rifampin for 4 to 8 weeks. The lavage was generally maintained for 3 to 7 days. The patients were allowed to walk unbearing 1 week postoperation, unbearing at least 2 months. Results Infections in 34 patients were effectively controlled after 3 to 19 months respectively. Among them, 2 presented spacer fracture (the stent was the intramedullary pin); 1 showed spacer dislocation; 2 patients (a Steinmann pin and a original femoral prosthesis as the stents for each) rejected revision; 2 patients had continued infections, received spacer removal and Girdstone opera-tion, and then 1 infection was effectively controlled, the other died due to complication. The successful rate was 94.7％. Conclusion Bone cement spacers are able to raise the successful rate to control the infection through slow local release of high-concentration antibiotics significantly and are helpful to maintain joint sta-bility, restrict the formation of scars, avoid lower limb length inequality, reimplant the prosthesis easily.
