术中自制抗生素骨水泥占位器在治疗髋关节置换术后感染的相关研究

发布时间：2018-07-10 07:23

本文选题：关节成形术 + 置换　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的研究术中自制抗生素骨水泥占位器在治疗髋关节置换术后感染的控制率及其并发症。方法对自2006年1月至2016年7月解放军总医院骨关节科髋关节置换术后感染行占位器植入患者共265例(266髋)进行回顾性研究,其中男性143例(144髋),女性122例(122髋)。占位器均为利用自行设计的压模器术中制作,全部占位器均加入万古霉素,同时根据细菌药敏结果加入另外一种的抗生素。记录是否行大粗隆延长截骨术(ETO)取感染假体、占位器并发症(断裂和脱位)的发生率、Harris评分和感染的控制率。结果占位器植入时患者的平均年龄是57.4±14.2岁。39例(14.7% )行ETO取出感染假体。38例(14.3%)出现了占位器的并发症,其中28例(10.5%)出现了占位器断裂,10例(3.8%)出现了占位器脱位。平均随访时间为83.4±14.6月。265例行占位器植入术Harris评分从术前的47.16±13.29上升到占位器植入术后的73.82±11.67 (P0.05 );其中256例(257髋)行二期假体植入术Harris评分从占位器术前的47.56±14.23到末次随访的86.43±12.84 (P0.05 )。占位器植入到二期假体植入时的时间为3-13月,平均时间间隔4.2±1.3月。256例(96.6%)的患者植入占位器术后感染得到了有效控制,并行二期手术。二期翻修术后到末次随访,4例复发感染,感染总的控制率为95.1%。结论术中自制抗生素骨水泥占位器在控制髋关节置换术后感染具有显著效果。占位器并发症发生率较低。占位器结合钢丝、钛缆、捆绑带、异体骨板及螺钉不影响感染的控制。
[Abstract]:Objective to study the control rate and complications of intraoperative antibiotic bone cement occupying apparatus in the treatment of infection after hip arthroplasty. Methods A retrospective study was conducted on 265 patients (266 hips) with infection after hip arthroplasty in orthopedic department of PLA General Hospital from January 2006 to July 2016, including 143 males (144 hips) and 122 females (122 hips). The space occupying devices were all made by using a self-designed mandrel, all of which were added vancomycin, and another antibiotic was added according to the results of bacterial drug sensitivity. The incidence of site occupying complications (breakage and dislocation), Harris score and infection control rate were recorded. Results the average age of the patients was 57.4 卤14.2 years old. 39 cases (14.7%) underwent Eto removal of infected prosthesis. 38 cases (14.3%) had complications of the occupying apparatus. Among them, 28 cases (10.5%) had the site occupying apparatus rupture and 10 cases (3.8%) had the dislocation of the occupying apparatus. The average follow-up time was 83.4 卤14.6 months. The Harris score increased from 47.16 卤13.29 to 73.82 卤11.67 (P0.05), and the Harris score of 256 cases (257 hips) underwent secondary prosthesis implantation from 47.56 卤14.23 to 86.43 卤12.84 (P0.05). The time of implantation of space occupying apparatus into secondary prosthesis was 3 to 13 months. The average time interval was 4.2 卤1.3 months. 256 patients (96. 6%) with space occupying apparatus implantation were effectively controlled. Four cases of recurrent infection were followed up from the second stage revision operation to the last time, the total infection control rate was 95.1%. Conclusion Self-made antibiotic bone cement occupying apparatus is effective in controlling infection after hip arthroplasty. The incidence of space occupying apparatus complications was low. The position holder combines steel wire, titanium cable, binding tape, allogeneic bone plate and screw without affecting infection control.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4

【相似文献】