CAJ | 학술논문

目的通过对自制压模成型抗生素骨水泥占位器在髋关节术后慢性感染二期手术中应用效果和作用的分析及文献学习,了解相关疾病的处理方法,提高诊治水平.方法回顾性分析2008年1月至2012年6月,经治的8例髋关节术后慢性感染患者,初次手术据诊断平均间隔4年,其中人工关节置换术后感染7例,股骨头坏死术后感染1例,均采用二期手术治疗,平均间隔时间13个月,一期使用术中自制含万古霉素的关节型骨水泥占位器进行治疗,待感染控制后行二期翻修,长柄骨水泥假体植入术.观察患者关节功能及满意度情况、感染的控制情况、占位器翻修及并发症等使用情况.结果8例均随访,Harris 评分由一期手术前的39分提高至术后的63分,二期翻修术后 Harris 评分86分,患者满意度100%,术后感染控制率均为100%,无感染复发,无早期假体松动情况,患者可使用占位器部分负重活动,未出现占位器脱位,出现1例占位器断裂.结论术中制作关节型抗生素骨水泥占位器二期手术可以较好的治疗髋关节术后感染,维持翻修期间关节功能,采用一些改良的技术可以减少相关并发症.
목적통과대자제압모성형항생소골수니점위기재관관절술후만성감염이기수술중응용효과화작용적분석급문헌학습,료해상관질병적처리방법,제고진치수평.방법회고성분석2008년1월지2012년6월,경치적8례관관절술후만성감염환자,초차수술거진단평균간격4년,기중인공관절치환술후감염7례,고골두배사술후감염1례,균채용이기수술치료,평균간격시간13개월,일기사용술중자제함만고매소적관절형골수니점위기진행치료,대감염공제후행이기번수,장병골수니가체식입술.관찰환자관절공능급만의도정황、감염적공제정황、점위기번수급병발증등사용정황.결과8례균수방,Harris 평분유일기수술전적39분제고지술후적63분,이기번수술후 Harris 평분86분,환자만의도100%,술후감염공제솔균위100%,무감염복발,무조기가체송동정황,환자가사용점위기부분부중활동,미출현점위기탈위,출현1례점위기단렬.결론술중제작관절형항생소골수니점위기이기수술가이교호적치료관관절술후감염,유지번수기간관절공능,채용일사개량적기술가이감소상관병발증.
Objective To understand the treating methods of relevant diseases and improve the diagnosis and treatment by analyzing the application effects and the role of antibiotic-loaded articulating cement spacer made by a self-made mold used in the two-stage treatment for chronic hip infection after the operation and studying the literatures. Methods A retrospective analysis of a group of 8 patients with chronic hip infection after the operation from January 2008 to June 2012 was performed, with an average spacing interval of 4 years from diagnosis to primary operation, including 7 patients with hip infection after artificial joint replacement and 1 patient with hip infection after the operation for femoral head necrosis. All patients were treated with two-stage procedures, with the average spacing interval of 13 months. In the first stage, vancomycin-loaded articulating cement spacer made by a self-made mold was used. The second-stage revisions were followed after the infection was controlled, with long-stem cement prostheses implanted. The function of hip joints, satisfaction degree of the patients and infection control rate were evaluated. The use of spacers were observed including the revisions and complications. Results All 8 patients were followed up. The Harris score elevated from 39 points to 63 points after the first-stage operation, and to 86 points after the second-stage revisions. The satisfaction degree of the patients was 100%. The infection control rate after the operation was 100%, with no recurrence of infection or early loosening of prostheses. The patients could do partial weight-bearing activities using the spacers. Fractures of the spacers occurred in 1 case with no dislocation of the spacers. Conclusions The hip infection after the operation can be well controlled in the two-stage treatment with the antibiotic-loaded articulating cement spacer made during the operation. The joint function can be maintained within the revision stage, and the relative complications can be reduced by some modified techniques.