中华骨科杂志
中華骨科雜誌
중화골과잡지
CHINESE JOURNAL OF ORTHOPAEDICS
2009年
5期
467-470
,共4页
李玉军%张春雨%周一新%张洪%周乙雄%殷建华%徐辉%李为%郭晓忠%黄野%黄德勇
李玉軍%張春雨%週一新%張洪%週乙雄%慇建華%徐輝%李為%郭曉忠%黃野%黃德勇
리옥군%장춘우%주일신%장홍%주을웅%은건화%서휘%리위%곽효충%황야%황덕용
关节成形术,置换,髋%感染%髋假体%再手术
關節成形術,置換,髖%感染%髖假體%再手術
관절성형술,치환,관%감염%관가체%재수술
Arthroplasty,replacement,hip%Infection%Hip prosthesis%Reoperation
目的 探讨人工髋关节置换术后感染二期关节再置换的假体选择.方法 1999年1月至2007年12月,共32例单侧人工髋关节置换术后感染二期关节再置换的患者,男19例,女13例,平均56岁(32～80岁).髋臼侧Paprosky骨缺损分型:Ⅰ型13例,ⅡA型9例,ⅡC型5例,ⅢA型1例,ⅢB型4例;对Ⅰ～ⅡA型髋臼骨缺损(22例),应用非骨水泥型假体;对ⅡC～ⅢB型髋臼骨缺损(10例),给予植骨、加强环和髋臼网等方法进行充分重建,应用骨水泥型假体.股骨侧Paprosky骨缺损分型:Ⅰ型11例,Ⅱ A型4例,ⅡB型1例,ⅡC型5例,ⅢA型6例,ⅢB型3例,ⅢC型2例;选用骨水泥型假体8例(ⅡC型5例,ⅢB型3例),近端固定生物型假体5例(Ⅰ型),广泛涂层型假体11例(Ⅰ型6例,ⅡA型4例,ⅡB型1例),远端同定型假体8例(ⅢA型6例,ⅢC型2例).结果 术后随访1～10年,平均5年2个月.术后2例患者反复发生感染,因患者拒绝再次取出假体,仅行清创和保守治疗;末次随访时仍存在窦道;Harris评分分别为65和78分.其余30例患者效果满意,Harris评分由二期手术前的平均48分(31～78分)提高到术后平均85分(80～95分).末次随访时X线片与术后当时的X线片对比,30例患者的假体均无下沉、移位和松动.结论 人工髋关节置换术后感染二期关节再置换手术的成功率高,手术重点是确认感染已获得良好控制后,针对骨缺损类型选择相应的假体.
目的 探討人工髖關節置換術後感染二期關節再置換的假體選擇.方法 1999年1月至2007年12月,共32例單側人工髖關節置換術後感染二期關節再置換的患者,男19例,女13例,平均56歲(32～80歲).髖臼側Paprosky骨缺損分型:Ⅰ型13例,ⅡA型9例,ⅡC型5例,ⅢA型1例,ⅢB型4例;對Ⅰ～ⅡA型髖臼骨缺損(22例),應用非骨水泥型假體;對ⅡC～ⅢB型髖臼骨缺損(10例),給予植骨、加彊環和髖臼網等方法進行充分重建,應用骨水泥型假體.股骨側Paprosky骨缺損分型:Ⅰ型11例,Ⅱ A型4例,ⅡB型1例,ⅡC型5例,ⅢA型6例,ⅢB型3例,ⅢC型2例;選用骨水泥型假體8例(ⅡC型5例,ⅢB型3例),近耑固定生物型假體5例(Ⅰ型),廣汎塗層型假體11例(Ⅰ型6例,ⅡA型4例,ⅡB型1例),遠耑同定型假體8例(ⅢA型6例,ⅢC型2例).結果 術後隨訪1～10年,平均5年2箇月.術後2例患者反複髮生感染,因患者拒絕再次取齣假體,僅行清創和保守治療;末次隨訪時仍存在竇道;Harris評分分彆為65和78分.其餘30例患者效果滿意,Harris評分由二期手術前的平均48分(31～78分)提高到術後平均85分(80～95分).末次隨訪時X線片與術後噹時的X線片對比,30例患者的假體均無下沉、移位和鬆動.結論 人工髖關節置換術後感染二期關節再置換手術的成功率高,手術重點是確認感染已穫得良好控製後,針對骨缺損類型選擇相應的假體.
목적 탐토인공관관절치환술후감염이기관절재치환적가체선택.방법 1999년1월지2007년12월,공32례단측인공관관절치환술후감염이기관절재치환적환자,남19례,녀13례,평균56세(32～80세).관구측Paprosky골결손분형:Ⅰ형13례,ⅡA형9례,ⅡC형5례,ⅢA형1례,ⅢB형4례;대Ⅰ～ⅡA형관구골결손(22례),응용비골수니형가체;대ⅡC～ⅢB형관구골결손(10례),급여식골、가강배화관구망등방법진행충분중건,응용골수니형가체.고골측Paprosky골결손분형:Ⅰ형11례,Ⅱ A형4례,ⅡB형1례,ⅡC형5례,ⅢA형6례,ⅢB형3례,ⅢC형2례;선용골수니형가체8례(ⅡC형5례,ⅢB형3례),근단고정생물형가체5례(Ⅰ형),엄범도층형가체11례(Ⅰ형6례,ⅡA형4례,ⅡB형1례),원단동정형가체8례(ⅢA형6례,ⅢC형2례).결과 술후수방1～10년,평균5년2개월.술후2례환자반복발생감염,인환자거절재차취출가체,부행청창화보수치료;말차수방시잉존재두도;Harris평분분별위65화78분.기여30례환자효과만의,Harris평분유이기수술전적평균48분(31～78분)제고도술후평균85분(80～95분).말차수방시X선편여술후당시적X선편대비,30례환자적가체균무하침、이위화송동.결론 인공관관절치환술후감염이기관절재치환수술적성공솔고,수술중점시학인감염이획득량호공제후,침대골결손류형선택상응적가체.
Objective To study surgical technique and choice of prosthesis in the second stage revision with infections of artificial hip replacement. Methods From January 1999 to December 2007, 32 patients with infections after unilateral hip replacement underwent the second stage revision, including 19 males and 13 females, with a mean age of 56 years (32-80 years). Bone defect in acetabular side by Paprosky classification were 13 cases(type Ⅰ), 9 cases(Ⅱ A), 5 cases(Ⅱ C), 1 cases(ⅢA), 4 cases(Ⅲ B). Cemeritless prosthesis was applied in 22 cases with type Ⅰ-Ⅱ A bone defect. Cemented prosthesis was applied in 10 cases with type Ⅱ C-Ⅲ B bone defect followed by acetabular reconstruction by allograft, mesh and cage or ring. Bone defect in femoral side by Paprosky classification were 11 cases(Ⅰ), 4 cases(Ⅱ A), 1 case (Ⅱ B), 5 cases(Ⅱ C), 6 cases(Ⅲ A), 3 cases(Ⅲ B), 2 cases(Ⅲ C). Cemented prosthesis was applied in 8 cases with type Ⅱ C (5 cases) and Ⅲ B(3 cases) bone defect. Cementless prosthesis was applied in the other cases, including proximal fixation(5 cases with type Ⅰ ), extensive prouscoating(6 cases with Ⅰ, 4 cases with Ⅱ A, 1 case with Ⅱ B) and distal fixation (6 cases with Ⅲ A, 2 cases with Ⅲ C). Results All cases were followed up i-10 years. Among them, 2 patients suffered recurrent infections, and underwent debridement and conservative treatment, with sinus tract at final follow-up. Harris score were 65 and 78, respectively. The other 30 cases got satisfactory results. Harris score was increased from average 48 (31-78) preoperatively to 85 (80-95) postoperatively. At final follow-up, 30 prosthesis had no subsidence, migration and loosening on X-ray images. Conclusion The success rate of two stage revision with infections of artificial hip replacement is satisfactory. The key point of revision is to choose proper prosthesis according to bone defect type after the infection is under better control.
