CAJ | 학술논문

目的探讨非骨水泥假体二期翻修治疗慢性髋关节假体周围感染的临床疗效.方法回顾性分析自2002年1月至2009年12月因髋关节假体周围慢性深部感染而采用非骨水泥股骨组件行二期翻修的23例患者资料,其中男性9例,女性14例；年龄52～ 78岁,平均(64±8)岁.所有患者一期手术彻底清创并插入含抗生素骨水泥间隔物,术后静脉使用敏感抗生素2周后改口服抗生素4周.一期取出假体术后平均6.7个月(3～28个月)采用非骨水泥股骨假体进行二期翻修术,术后静脉使用抗生素2周后改口服抗生素4周,然后停药.观察统计手术相关并发症,评估关节功能及治疗效果.结果术后平均随访(4.3±3.5)年,所有病例中2例再次发生感染,有3例发生术中骨折,1例在两次手术中间发生间隔物脱位,二期翻修手术后共2例发生脱位.所有病例中1例患者出现股骨柄轻度下沉,所有感染未复发病例均没有发生股骨组件和非骨水泥髓臼组件的松动.Harris评分从术前(36±13)分上升到术后12个月(85±13)分.结论采用非骨水泥假体二期翻修治疗髋关节假体周围慢性感染可以获得良好的感染控制率和假体稳定性,但对耐药菌感染的治疗采用非骨水泥假体时需要慎重.
목적 탐토비골수니가체이기번수치료만성관관절가체주위감염적림상료효.방법 회고성분석자2002년1월지2009년12월인관관절가체주위만성심부감염이채용비골수니고골조건행이기번수적23례환자자료,기중남성9례,녀성14례；년령52～ 78세,평균(64±8)세.소유환자일기수술철저청창병삽입함항생소골수니간격물,술후정맥사용민감항생소2주후개구복항생소4주.일기취출가체술후평균6.7개월(3～28개월)채용비골수니고골가체진행이기번수술,술후정맥사용항생소2주후개구복항생소4주,연후정약.관찰통계수술상관병발증,평고관절공능급치료효과.결과 술후평균수방(4.3±3.5)년,소유병례중2례재차발생감염,유3례발생술중골절,1례재량차수술중간발생간격물탈위,이기번수수술후공2례발생탈위.소유병례중1례환자출현고골병경도하침,소유감염미복발병례균몰유발생고골조건화비골수니수구조건적송동.Harris평분종술전(36±13)분상승도술후12개월(85±13)분.결론 채용비골수니가체이기번수치료관관절가체주위만성감염가이획득량호적감염공제솔화가체은정성,단대내약균감염적치료채용비골수니가체시수요신중.
Objective To determine the clinical outcomes of two-staged cementless revision arthroplasty for the treatment of deep periprosthetic infection after total hip arthroplasty.Methods Twentythree patients with deep periprosthetic infection treated with a standard protocol of two-staged cementless revision hip arthroplasty were enrolled in this study.There were 9 male patients and 14 female patients with an average age of 64 years (range,52-78 years). In all cases,antibiotics-loaded cement spacers were implanted after removal of all the prosthetic components and thorough debridements had been done. All patients had a minimum of 2 weeks of intravenous antibiotics followed by 4 weeks of oral antibiotics after implant removal.After a mean interval of 6.7 months (3-28 months),revision arthroplasties were carried out with cementless femoral components followed by 2 weeks of intravenous antibiotics and 4 weeks of oral antibiotics.Results The mean follow-up period was ( 4.3 ± 3.5 ) years.There were 2 cases of recurrent infections in this study.Intraoperative periprosthetic fractures were observed in 3 patients.One patient had dislocation of the implanted spacer during the interval period and 2 patients had hip dislocation after reimplantation.Mild subsidence of femoral component occurred in 1 patient. There were no cases of loosening of femoral components and cementless acetabular components in patients without infection recurrence.The Harris hip score increased from a preoperative mean of 36 ± 13 to 85 ± 13 at 12 months after reimplantation.Conclusions Using cementless prostheses in two-staged revisions of hip periprosthetic infections can provide low rate of infection recurrence and good implant stability,but cautions must be taken when treating patients with infection caused by multidrug-resistant organisms.