CAJ | 학술논문

　　目的探讨通过窦道冲洗置药治疗髋关节置换术后假体周围感染的临床效果。方法2005年9月至2011年9月，安徽省立医院和安徽省第二人民医院收住全髋关节置换术后假体感染的患者18例，患者早期感染为7例，中期感染8例，晚期感染3例，患者均无明显发热，引流液均行培养和药敏检查，均培养出细菌。采用无菌管通过窦道置入关节腔，分别使用生理盐水，过氧化氢进行反复冲洗，根据药敏试验选择敏感抗生素通过无菌管置入关节腔，并保留无菌管用作引流，根据引流量决定冲洗置药次数。换药后嘱患者持拐下床活动，后期引流量较少，细菌培养3次阴性，冲洗置药后可拔出无菌管，随后窦道可愈合。治疗中定期复查血常规，生化，C 反应蛋白( CRP )，血沉( ESR )。保持较好营养状态。结果18例经3周治疗，窦道愈合，髋关节 Harris 评分由术前平均35.8分提高到术后70.6分，血常规恢复正常，CRP 平均在30 mg/L，ESR 平均在35.6 mm/h。除1例因医疗纠纷选择手术取出假体外，其余17例临床效果满意。结论对于部分全髋关节置换术后假体感染病情平稳的患者，通过加强营养，使用无菌管通过窦道置入关节腔进行反复冲洗，根据药敏试验选择敏感抗生素通过无菌管置入关节腔，可达到窦道愈合，髋关节功能恢复的效果。
　　목적탐토통과두도충세치약치료관관절치환술후가체주위감염적림상효과。방법2005년9월지2011년9월，안휘성립의원화안휘성제이인민의원수주전관관절치환술후가체감염적환자18례，환자조기감염위7례，중기감염8례，만기감염3례，환자균무명현발열，인류액균행배양화약민검사，균배양출세균。채용무균관통과두도치입관절강，분별사용생리염수，과양화경진행반복충세，근거약민시험선택민감항생소통과무균관치입관절강，병보류무균관용작인류，근거인류량결정충세치약차수。환약후촉환자지괴하상활동，후기인류량교소，세균배양3차음성，충세치약후가발출무균관，수후두도가유합。치료중정기복사혈상규，생화，C 반응단백( CRP )，혈침( ESR )。보지교호영양상태。결과18례경3주치료，두도유합，관관절 Harris 평분유술전평균35.8분제고도술후70.6분，혈상규회복정상，CRP 평균재30 mg/L，ESR 평균재35.6 mm/h。제1례인의료규분선택수술취출가체외，기여17례림상효과만의。결론대우부분전관관절치환술후가체감염병정평은적환자，통과가강영양，사용무균관통과두도치입관절강진행반복충세，근거약민시험선택민감항생소통과무균관치입관절강，가체도두도유합，관관절공능회복적효과。
Objective To investigate the clinical results of antibacterial irrigation through the sinus tract for periprosthetic infection after hip arthroplasty. Methods From September 2005 to September 2011, 18 patients with periprosthetic infection after total hip arthroplasty ( THA ) were adopted in Anhui Provincial Hospital and Anhui Provincial No.2 People’s Hospital. Early infection occurred in 7 cases, interim infection in 8 cases and advanced infection in 3 cases. No significant fever was observed in all patients. The drainage fluid was cultured and drug susceptibility test was performed, with bacteria cultured. The sterile tube was inserted into the articular cavity through the sinus tract, which was repeatedly irrigated by normal saline and hydrogen peroxide respectively. The sensitive antibiotics were selected according to the drug susceptibility test, and then were inserted into the articular cavity through the sterile tube, which was kept for drainage. The times of antibacterial irrigation were determined by the drainage volume. After dressing changing, the patients were instructed to be on crutches out of bed. In the late stage, the drainage volume became less. Bacteria were cultured for 3 times to show negative results. The sterile tube was pulled out after antibacterial irrigation, and then the sinus tract got healed. The blood routine, biochemistry, C-reactive protein ( CRP ) and erythrocyte sedimentation rate ( ESR ) were reviewed regularly in the treatment. Good nutritional status was maintained. Results After 3 weeks of treatment, the sinus tract got healed. The Harris hip score increased from an average of 35.8 points preoperatively to 70.6 points postoperatively. The blood routine was back to normal. The CRP was 30 mg/L on average, and the ESR was 35.6 mm/h on average. Except for 1 patient who chose to take out the prosthesis because of medical disputes, the other 17 patients were satisfied with the clinical results. Conclusions With nutrition strengthened, in some patients in stable conditions with prosthesis infection after total hip replacement, the sterile tube is inserted into the articular cavity through the sinus tract to irrigate repeatedly. The sensitive antibiotics are selected according to the drug susceptibility test, and then are inserted into the articular cavity through the sterile tube. The sinus tract can get healed, and the function of hip joints can get recovered.