二期翻修手术治疗髋关节置换术后假体周围感染的临床疗效分析
发布时间：2018-08-19 11:33
【摘要】：[目的]分析人工髋关节置换术(total hip arthroplasty,THA)术后假体周围感染(periprostheticjointinfection,PJI)行二期翻修手术治疗的病例,评价二期翻修手术的临床疗效,并探讨二次手术的时机。[方法]回顾分析2011年2月到2016年2月昆明医科大学第一附属医院骨科收治的THA术后PJI行二期翻修手术治疗的患者32例。其中男性19例,女性13例,平均年龄65.4(42-75)岁,初次置换术后发生感染时间平均2.5年(术后2月-7年),14例患者合并窦道,15例患者术前窦道分泌物或关节液细菌培养阳性。28 例患者出现血沉(erythrocyte sedimentation rate,ESR)和 C 反应蛋白(C-reactive protein,CRP)明显升高;4例患者CRP升高,ESR正常。所有患者均行二期翻修手术治疗,一期彻底清除感染坏死组织、取出关节假体和骨水泥等异物,并植入自制关节型万古霉素骨水泥假体,术后采用敏感抗生素全身抗感染治疗,感染控制后二期植入新假体翻修。所有患者均在一般情况稳定、症状体征缓解、ESR和CRP恢复正常且保持平稳1月后,进行二期新假体翻修,间隔时间6周-16周,平均8周。术后定期随访,通过患者的Harris评分、症状体征、血液学以及影像学检查结果对手术效果进行评估。[结果]所有患者一期清创术后病理检查均支持感染诊断,29例患者行全髋关节翻修,3例患者单纯股骨柄翻修,手术切口均I期愈合。32例患者均得到长期随访,平均随访时间19.5月(12-48月)。Harris评分由术前(31.1±12.3)分,提高至术后 3 月(58.2±11.0)分、术后 6 月(67.5±10.9)分、术后 1 年(78.2±10.3)分,差异有统计学意义。术前ESR(43.3±20.4)mm/h,术后1年(15.1±5.9)mm/h;CRP 术前(43.8±18.6)mg/L,术后 1 年(8.9±5.5)mg/L。至末次随访,除1例单纯股骨柄翻修患者术后12月感染复发,ESR和CRP持续高于正常水平、症状体征无明显改善外,其余患者症状体征均明显改善,感染无复发,X线显示假体位置良好,未出现松动、骨质溶解等并发症,感染控制率达到97%。[结论]1、髋关节置换术后假体周围感染的治疗中,二期翻修手术临床效果安全可靠。2、术中彻底清创、术后抗感染治疗以及翻修时机的把握是手术成功的关键因素。3、二期翻修手术治疗髋关节置换术后假体周围感染,在一期清创术后,病人一般情况稳定、症状体征缓解、ESR和CRP恢复正常且保持平稳1月时进行二次手术,手术时机恰当。
[Abstract]:[objective] to analyze the cases of peri-prosthetic infection (PJI) after (total hip arthroplasty (tha), to evaluate the clinical effect of the second-stage revision operation, and to explore the opportunity of secondary revision operation. [methods] from February 2011 to February 2016, 32 patients with PJI undergoing second stage revision surgery after THA were treated in the Department of Orthopaedics, first affiliated Hospital of Kunming Medical University. There were 19 males and 13 females, with an average age of 65.4 (42-75) years, Infection occurred in an average of 2.5 years (2 months to 7 years after operation) after initial replacement. 14 patients with sinus tract infection and 15 patients with sinus tract secretion or joint fluid culture positive before operation. 28 patients developed ESR (erythrocyte sedimentation ratee ESR and C-reactive protein C-reactive levels were significantly increased in 4 patients with elevated CRP. All the patients were treated with second stage revision surgery. The infected necrotic tissue was completely removed in one stage. Foreign bodies such as joint prosthesis and bone cement were removed, and self-made vancomycin bone cement prosthesis was implanted. After the operation, sensitive antibiotics were used to treat the infection. After infection control, a new prosthesis was implanted. All the patients were stable in general condition, symptom and sign relief, CRP and ESR were restored to normal and kept steady for 1 month, then the second phase of prosthetic revision was performed, with an interval of 6 weeks to 16 weeks, with an average of 8 weeks. Postoperative outcomes were assessed by Harris scores, symptoms and signs, hematology, and imaging findings. [results] all the patients were confirmed by pathological examination after primary debridement. 29 patients underwent revision of total hip joint, 3 patients had simple femoral pedicle revision. All the patients were followed up for a long time. The mean follow-up time was 19.5 months (12-48 months). Harris score increased from (31.1 卤12.3) to (58.2 卤11.0) in 3 months, (67.5 卤10.9) in 6 months, and (78.2 卤10.3) in 1 year after operation. ESR was (43.3 卤20.4) mm / h before operation, (15.1 卤5.9) mm / h after operation, (43.8 卤18.6) mg / L before operation, and (8.9 卤5.5) mg / L at 1 year postoperatively. At the last follow-up, the symptoms and signs of one patient with simple femoral pedicle revision were significantly improved, except for one patient with recurrent infection 12 months after operation, the level of ESR and CRP remained higher than the normal level, and the symptoms and signs of the patients were not obviously improved. X-ray showed that the prosthesis was in good position without loosening and osteolysis. The infection control rate was 97%. [conclusion] 1. In the treatment of periprosthetic infection after hip arthroplasty, the clinical effect of the second stage revision operation is safe and reliable. Postoperative anti-infective treatment and timing of revision were the key factors for successful operation. The second stage revision surgery for periprosthetic infection after hip arthroplasty was generally stable after primary debridement. Symptoms and signs were relieved, ESR and CRP returned to normal and kept steady for 1 month, and the time of operation was appropriate.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
[Abstract]:[objective] to analyze the cases of peri-prosthetic infection (PJI) after (total hip arthroplasty (tha), to evaluate the clinical effect of the second-stage revision operation, and to explore the opportunity of secondary revision operation. [methods] from February 2011 to February 2016, 32 patients with PJI undergoing second stage revision surgery after THA were treated in the Department of Orthopaedics, first affiliated Hospital of Kunming Medical University. There were 19 males and 13 females, with an average age of 65.4 (42-75) years, Infection occurred in an average of 2.5 years (2 months to 7 years after operation) after initial replacement. 14 patients with sinus tract infection and 15 patients with sinus tract secretion or joint fluid culture positive before operation. 28 patients developed ESR (erythrocyte sedimentation ratee ESR and C-reactive protein C-reactive levels were significantly increased in 4 patients with elevated CRP. All the patients were treated with second stage revision surgery. The infected necrotic tissue was completely removed in one stage. Foreign bodies such as joint prosthesis and bone cement were removed, and self-made vancomycin bone cement prosthesis was implanted. After the operation, sensitive antibiotics were used to treat the infection. After infection control, a new prosthesis was implanted. All the patients were stable in general condition, symptom and sign relief, CRP and ESR were restored to normal and kept steady for 1 month, then the second phase of prosthetic revision was performed, with an interval of 6 weeks to 16 weeks, with an average of 8 weeks. Postoperative outcomes were assessed by Harris scores, symptoms and signs, hematology, and imaging findings. [results] all the patients were confirmed by pathological examination after primary debridement. 29 patients underwent revision of total hip joint, 3 patients had simple femoral pedicle revision. All the patients were followed up for a long time. The mean follow-up time was 19.5 months (12-48 months). Harris score increased from (31.1 卤12.3) to (58.2 卤11.0) in 3 months, (67.5 卤10.9) in 6 months, and (78.2 卤10.3) in 1 year after operation. ESR was (43.3 卤20.4) mm / h before operation, (15.1 卤5.9) mm / h after operation, (43.8 卤18.6) mg / L before operation, and (8.9 卤5.5) mg / L at 1 year postoperatively. At the last follow-up, the symptoms and signs of one patient with simple femoral pedicle revision were significantly improved, except for one patient with recurrent infection 12 months after operation, the level of ESR and CRP remained higher than the normal level, and the symptoms and signs of the patients were not obviously improved. X-ray showed that the prosthesis was in good position without loosening and osteolysis. The infection control rate was 97%. [conclusion] 1. In the treatment of periprosthetic infection after hip arthroplasty, the clinical effect of the second stage revision operation is safe and reliable. Postoperative anti-infective treatment and timing of revision were the key factors for successful operation. The second stage revision surgery for periprosthetic infection after hip arthroplasty was generally stable after primary debridement. Symptoms and signs were relieved, ESR and CRP returned to normal and kept steady for 1 month, and the time of operation was appropriate.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R687.4
【参考文献】
相关期刊论文 前10条
1 Drexler;Kuzyk P R;Koo K;胡孔足;;抗生素骨水泥髋臼顶可增强人工髋关节感染翻修骨水泥占位器的稳定性[J];临床骨科杂志;2016年03期
2 张东霞;李国红;侯照银;张淑英;高桃;;人工髋关节置换术后患者感染病原菌分析[J];中华医院感染学杂志;2016年06期
3 王景;徐瑞;张海鸿;;聚维酮碘溶液冲洗对骨科Ⅰ类切口术后感染的影响[J];临床骨科杂志;2016年01期
4 刘刚;刘群;杨顺杰;王溶;王坤;;人工髋关节置换术后感染的临床特点与干预措施分析[J];中华医院感染学杂志;2015年23期
5 郭学峰;伏鸿博;张可明;曹文;董强;;髋关节置换患者术后医院感染流行病学特征与危险因素分析[J];中华医院感染学杂志;2015年08期
6 赵智越;齐欣;杨晨;李叔强;;大转子延长截骨术在人工全髋关节翻修术中的临床应用进展[J];中国骨伤;2015年03期
7 王北岳;周利武;张志强;郭亭;赵建宁;;大臼杯在髋臼骨缺损患者的髋关节翻修术中的应用[J];中国骨与关节杂志;2014年06期
8 吴颖娜;方欢;范晓玲;曾宪铁;;骨科手术患者医院感染的调查分析[J];中华医院感染学杂志;2014年08期
9 沈灏;王俏杰;蒋W，
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