CAJ | 학술논문

目的总结使用自制压模器制成的关节型抗生素骨水泥占位器在人工髋关节置换术后感染二期翻修中应用的经验与教训,评价其在髋关节置换术后感染二期翻修中的效果和作用.方法 2005年8月至2009年12月采用二期翻修治疗的髋关节置换术后感染的患者中,127例患者在一期彻底清除后,植入了使用自制压模器术中制成的关节型抗生素骨水泥占位器,待感染控制后行二期翻修.其中106例患者107髋获得随访.观察使用这种占位器控制感染的有效率,制作、植入及取出的方便程度和出现的并发症,特殊情况的使用,观察患者的功能和满意程度.结果 106例患者平均随访时间34.3个月(3～55个月),一次感染控制率为96.3%,经过二期翻修末次随访时感染控制率为94.4%.占位器柄断裂4.7%,脱位率为2.8%,二期翻修时占位器取出困难者14.0%.患者满意率为93.5%.结论使用自制压模器制成的关节型抗生素骨水泥占位器在人工髋关节置换术后感染的二期翻修治疗中,具有制作简单、重复性好、感染控制率高、保留关节功能好、患者满意率高等优点,通过改进方法后可以减少断裂及取出困难问题,结合使用金属内固定或异体骨不会影响感染的控制率.
목적 총결사용자제압모기제성적관절형항생소골수니점위기재인공관관절치환술후감염이기번수중응용적경험여교훈,평개기재관관절치환술후감염이기번수중적효과화작용.방법 2005년8월지2009년12월채용이기번수치료적관관절치환술후감염적환자중,127례환자재일기철저청제후,식입료사용자제압모기술중제성적관절형항생소골수니점위기,대감염공제후행이기번수.기중106례환자107관획득수방.관찰사용저충점위기공제감염적유효솔,제작、식입급취출적방편정도화출현적병발증,특수정황적사용,관찰환자적공능화만의정도.결과 106례환자평균수방시간34.3개월(3～55개월),일차감염공제솔위96.3%,경과이기번수말차수방시감염공제솔위94.4%.점위기병단렬4.7%,탈위솔위2.8%,이기번수시점위기취출곤난자14.0%.환자만의솔위93.5%.결론 사용자제압모기제성적관절형항생소골수니점위기재인공관관절치환술후감염적이기번수치료중,구유제작간단、중복성호、감염공제솔고、보류관절공능호、환자만의솔고등우점,통과개진방법후가이감소단렬급취출곤난문제,결합사용금속내고정혹이체골불회영향감염적공제솔.
Objectives To summarize the experience and lessons of the using of antibiotic-loaded cement articulating spacer made by a self-made mold system for the treament of the infected hip replacement, and to evaluate its efficiency and role in the two-stage revison of infected total hip arthroplasty (THA). Methods The patients with infected THA treated with two-stage revision protocol from August 2005 to December 2009 were reviewed. All of the 127 patients were debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer made by a self-made mold system; Two-stage revisions were not followed until] the infection were controlled. Among of them, 106 patients, 107 hips were gotten fully followed up. Evaluations were made for the efficiency of infection control, convenience of making, implantating and removing of the spacers, occurrence of complications, the deal of the special circumstances, the function and satisfaction of the patients. Results The 107 hips were gotten an average of 34. 3 months' (3-55 months) follow-up. The infection control rate was 96. 3% after the first-stage surgery, the infection control rate was 94.4% at last follow-up after two-stage revisions. The breakage rate of the spacer was 4.7% , dislocation rate was 2. 8% , removal of the spacers with difficulty were seen in 15 patients ( 14.0% ). The satisfactory rate of the patients was 93. 5% . Conclusions Antibiotic-loaded cement articulating spacer made by a self-made mold system is an effective methods for the two-stage revision of the infected hip replacement, characterized by simple, good reproducible, high rates of infection control, better joint function after surgeries, high rate of patients satisfaction and other advantages. And it can decrease the complications, such as the breakage, spacer dislocation of hip joint and difficulty in removeral of spacer at the second stage revision. Using of metallic internal fixation or allograft bone combined with spacer does not affect the results of infection controlling.