【作者】 王建华；

【导师】 雪原；

【作者基本信息】 天津医科大学 ， 外科学（专业学位）， 2014， 硕士

【摘要】 目的：探讨应用抗生素骨水泥间隔体二期全髋关节置换治疗髋部手术后慢性感染的临床疗效。方法：从2007年1月至2012年6月应用二期全髋关节置换连续治疗髋部手术后感染患者16例,男12例,女4例；年龄43-76岁,平均(60.7±8.2)岁。髋关节置换术后8例,股骨颈骨折行加压螺钉固定3例,转子间骨折DHS固定3例,股骨头坏死骨瓣移植2例。一期手术彻底清创,植入抗生素(万古霉素)骨水泥间隔体,感染控制后二期植入全髋关节假体。术后定期随访,常规复查红细胞沉降率(erythrocyte sedimentation rate, ESR)C反应蛋白(C-reactiveprotein, CRP),摄髋关节正侧位X线片,采用Harris髋关节评分评估髋关节功能。结果：所有患者均获得随访,随访时间6-70个月,平均38个月。15例患者在一期清创植入骨水泥间隔体后平均14周(12-18周)行二期全髋关节置换,1例患者在一期清创后7个月行二次清创及重新植入骨水泥间隔体,12周后行二期全髋关节置换。二期全髋关节置换术采用非骨水泥型假体或组合式假体。Harris髋关节评分从术前平均34.6±3.4分,间隔期平均58.8±5.5分提高至末次随访平均91.3±6.7分,差异有统计学意义。随访期间未出现感染复发及新发感染病例。结论：对继发于髋部手术的髋关节感染,应用抗生素骨水泥间隔体行二期全髋关节置换可以获得较满意的近期疗效。更多还原

【Abstract】 Objective:To evaluate effect of two-stage exchange total hip arthroplasty(THA) using an antibiotic-loaded cement spacer in the treatment of hip infection secondary to hip surgery.Method:From January2007to June2012,16consecutive patients with infected hip secondary to hip surgery, including12males and4females, aged from43to76years (average,60.7±8.2years) were treated with two-stage exchange THA. There were8cases with hip infection afer artifical joint replacement.There were3cases of femoral neck fracture treated with compressions crews fixation,3cases of intertrochanteric fracture treated with DHS, and2cases of early stage femoral head necrosis treated with core decompression and local interventional therapy respectively. Debridement and insertion of antibiotic-loadedcement spacer was performed in the first stage. After eradication of infection, it was converted to THA in the second stage. All patients were followed upregularly. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were tested. Harris score was used to evaluate the function of the hips.Result:All patients were followed up for anaverage of38months (range,6to70months). Fifteen patients were successfully converted to THA after anaverage of14weeks. One patient accepted the second debridement and reinsertion of a spacer after7months owing to the abnormal values of ESR and CRP; this case was converted to THA successfully12weeks after the second debridement. Harris hips core improved from preoperative34.6±3.4to58.8±5.5between the two stages and91.3±6.7at final follow-up. One patient suffered deep vein thrombosis in the infected extremity and pulmonary embolism. There was no reinfection after THA.Conclusion:Two-stage exchange THA using anantibiotic-loaded cement spacer can obtain satisfactory results for the treatment of hip infections econdary to the hip surgery.更多还原