摘要
目的探讨人工全髋关节置换术后深部感染的诊断和治疗方法。方法回顾性分析2000-07-2006-06收治的7例人工髋关节置换术后感染的病例,通过对临床表现、实验室检查、影像学检查、关节穿刺液培养、术中病灶组织涂片及培养综合分析,明确诊断为人工髋关节置换术后深部感染。治疗包括:保留假体的感染灶清除术1例;Ⅰ期翻修4例,均用抗生素骨水泥固定;Ⅱ期翻修2例,取出假体彻底清创后,1例安置自制抗生素骨水泥团,另1例未放置间隔器,给予置管抗生素液冲洗引流,感染控制后安放翻修假体,抗生素骨水泥固定。结果术后全部患者得到随访,随访时间7-72个月,平均18.6个月,感染均无复发。Harris评分平均为85.3(58-96)。结论人工髋关节置换术后深部感染诊断和治疗都是困难的,保留假体感染灶清除术的选择要慎重,Ⅰ、Ⅱ期翻修术是治疗的有效方法。
Objective To investigate the methods of diagnosis and treatment for deep infection after hip arthroplasty. Methods From July 2000 to June 2006, 12 patients with deep infection after hip arthroplasty were analyzed retrospectively. There were four males and three females with average of 65 years, ranging from 40 to 72 years. The diagnosis of deep infection after hip arthroplasty was based on clinical situation, laboratory examination, imaging examination, hip pucture fluid culture, intraoperative frozen section and tissue cultures. Treatment strategies include： debridement and retain prothesis were performed in one patient; one- stage exchange arthroplasty was performed in 4 patients, all fixated with antibiotic- impregnated cement; two- stage exchange arthroplasty was performed in 2 patients, After thorongh irriga- tion and debfidement of the infected joint and the removal of the femoral and acetabular components, an antibiotic- loaded bulb was inserted between the first and second stage in one patient, the instillation of antibiotic solution and drainage were performed in the other patient who did not inserted temporary spacer. The final prostheses were fixed with antibiotic - loaded cement after the infection was eliminated. Results All 7 patients were followed up for a period of 7 to 72 months. None of recurrent infection was found during the average 18.6 months follow- up. All 7 patients had postoperative Harris hip score average 85.3（58 - 96）. Conclusions The diagnosis and treatment of the infection after hip replacement is very difficult, the debridement and retention of prothesis must be careful, one - stage and two stage exchange arthroplasty were effective method for treating postoperative deep infection after total hip arthroplasty.
出处
《黑龙江医学》
2007年第4期241-243,共3页
Heilongjiang Medical Journal
关键词
关节成形术
置换
髋
感染
治疗
Arthroplasty
Replacement
Hip
Infection
Treatment
