摘要
目的比较两种不同抗生素给药方式的关节型占位器在全髋关节置换术后感染治疗中的效果,为全髋关节置换术后感染二期翻修手术中占位器的选择提供依据。方法自2002年3月-2007年5月,按门诊就诊顺序共收治明确诊断的全髋关节置换术后感染病人36例(40髋),分别应用抗生素骨水泥占位器与灌注冲洗型占位器行二期翻修治疗,其中抗生素骨水泥占位器26例(29髋),灌注冲洗型占位器10例(11髋)。记录两种占位器植入手术时间、术中出血量、术后卧床时间、住院时间、下地第1天及二期翻修术前1天髋关节功能、占位器植入次数、重建手术后最近一次随访的感染控制情况等指标。其中髋关节功能采用Harris评分及ROM(range of motion)测量,术前、术后常规摄X片对比。结果所有患者均获得随访,其中1例因死亡而随访至翻修术后34个月。通过对比发现,抗生素骨水泥占位器较灌注冲洗型占位器平均植入操作时间短(2.52±0.79 h/(3.29±0.33)h,P<0.01),术中出血量少(1208.57±275.64 ml/2131.82±596.84 ml,P<0.01),术后卧床时间短(6.14±1.98 d/45.18±6.11 d,P=0.00),住院时间短(26.00±3.27 d/53.63±3.35 d,P=0.00),占位器植入后感染控制率高(100%/81.82%,P<0.01);而下地第1天两组平均Harris评分相似(56.85±9.61/56.41±6.31),屈伸ROM结果类似(75.31°±6.34°/76.09°±5.49°),翻修术前抗生素骨水泥占位器组平均Harris评分更高(86.78±7.49/80.35±6.37,P<0.05),屈伸ROM差别也不显著(95.16°±4.47°/97.35°±6.22°)。结论在治疗髋关节置换术后感染中,抗生素骨水泥型占位器较灌注冲洗型占位器具有植入操作时间短,术中出血量少,术后卧床时间短,住院时间短,下地后功能更好及无需长期灌注冲洗等优点。
Objectives To compare antibiotic-impregnated cement spacer and antibiotic irrigating metal spacer in the treatment of infections after total hip arthroplasty(THA) and to determine which is better in the two-stage revision of the infected THA.Method Thirty-six consecutive patients with infection around hip prosthesis were treated from March 2002 to December 2007 in our center,which included forty hips in total.Among them,twenty-six patients were treated with antibiotic-impregnated cement spacer and ten patients were treated with antibiotic irrigating metal spacer.All the patients were assessed by operation time,blood loss during the spacer implantation,time of hospitalization and staying in bed,joint function analysis by Harris score system,and ROM of flexion and extention.X - ray photograph was routinely taken.Results Follow-up for all the patients were gained except one died of MOF 34 months after the revison.Results showed that the patients with antibiotic-impregnated cement spacers gained less operation time(2.52±0.79 vs 3.29±0.33,P<0.01),less blood loss1208.57±275.64/2131.82±596.84,P=0.00),less time of staying in bed after the first OP(6.14±1.98/45.18±6.11,P=0.00) and shorter hospital stay time(26.00±3.27/53.63±3.35,P= 0.00),higher control rate of infection in the interval(100%/81.82%,P<0.01),better function before the second OP(86.78±7.49/80.35±6.37,P<0.05) and free of long-term irrigation.Conclusion Comparing with antibiotic irrigating metal spacers,our self-made antibiotic-impregnated cement spacers have many advantages mentioned in result above.As a result,we recommend this antibiotic-impregnated cement spacer as a standard to be used.
出处
《中国骨与关节外科》
2008年第2期118-123,共6页
Chinese Journal of Bone and Joint Surgery
关键词
全髋关节置换术
感染
二期翻修
占位器
total hip arthroplasty/replacement
infection
two-stage revision
spacer
