發(fā)布時(shí)間：2018-08-19 11:33

【摘要】：[目的]分析人工髖關(guān)節(jié)置換術(shù)(total hip arthroplasty,THA)術(shù)后假體周圍感染(periprostheticjointinfection,PJI)行二期翻修手術(shù)治療的病例,評價(jià)二期翻修手術(shù)的臨床療效,并探討二次手術(shù)的時(shí)機(jī)。[方法]回顧分析2011年2月到2016年2月昆明醫(yī)科大學(xué)第一附屬醫(yī)院骨科收治的THA術(shù)后PJI行二期翻修手術(shù)治療的患者32例。其中男性19例,女性13例,平均年齡65.4(42-75)歲,初次置換術(shù)后發(fā)生感染時(shí)間平均2.5年(術(shù)后2月-7年),14例患者合并竇道,15例患者術(shù)前竇道分泌物或關(guān)節(jié)液細(xì)菌培養(yǎng)陽性。28 例患者出現(xiàn)血沉(erythrocyte sedimentation rate,ESR)和 C 反應(yīng)蛋白(C-reactive protein,CRP)明顯升高;4例患者CRP升高,ESR正常。所有患者均行二期翻修手術(shù)治療,一期徹底清除感染壞死組織、取出關(guān)節(jié)假體和骨水泥等異物,并植入自制關(guān)節(jié)型萬古霉素骨水泥假體,術(shù)后采用敏感抗生素全身抗感染治療,感染控制后二期植入新假體翻修。所有患者均在一般情況穩(wěn)定、癥狀體征緩解、ESR和CRP恢復(fù)正常且保持平穩(wěn)1月后,進(jìn)行二期新假體翻修,間隔時(shí)間6周-16周,平均8周。術(shù)后定期隨訪,通過患者的Harris評分、癥狀體征、血液學(xué)以及影像學(xué)檢查結(jié)果對手術(shù)效果進(jìn)行評估。[結(jié)果]所有患者一期清創(chuàng)術(shù)后病理檢查均支持感染診斷,29例患者行全髖關(guān)節(jié)翻修,3例患者單純股骨柄翻修,手術(shù)切口均I期愈合。32例患者均得到長期隨訪,平均隨訪時(shí)間19.5月(12-48月)。Harris評分由術(shù)前(31.1±12.3)分,提高至術(shù)后 3 月(58.2±11.0)分、術(shù)后 6 月(67.5±10.9)分、術(shù)后 1 年(78.2±10.3)分,差異有統(tǒng)計(jì)學(xué)意義。術(shù)前ESR(43.3±20.4)mm/h,術(shù)后1年(15.1±5.9)mm/h;CRP 術(shù)前(43.8±18.6)mg/L,術(shù)后 1 年(8.9±5.5)mg/L。至末次隨訪,除1例單純股骨柄翻修患者術(shù)后12月感染復(fù)發(fā),ESR和CRP持續(xù)高于正常水平、癥狀體征無明顯改善外,其余患者癥狀體征均明顯改善,感染無復(fù)發(fā),X線顯示假體位置良好,未出現(xiàn)松動(dòng)、骨質(zhì)溶解等并發(fā)癥,感染控制率達(dá)到97%。[結(jié)論]1、髖關(guān)節(jié)置換術(shù)后假體周圍感染的治療中,二期翻修手術(shù)臨床效果安全可靠。2、術(shù)中徹底清創(chuàng)、術(shù)后抗感染治療以及翻修時(shí)機(jī)的把握是手術(shù)成功的關(guān)鍵因素。3、二期翻修手術(shù)治療髖關(guān)節(jié)置換術(shù)后假體周圍感染,在一期清創(chuàng)術(shù)后,病人一般情況穩(wěn)定、癥狀體征緩解、ESR和CRP恢復(fù)正常且保持平穩(wěn)1月時(shí)進(jìn)行二次手術(shù),手術(shù)時(shí)機(jī)恰當(dāng)。
[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 鹵12.3) to (58.2 鹵11.0) in 3 months, (67.5 鹵10.9) in 6 months, and (78.2 鹵10.3) in 1 year after operation. ESR was (43.3 鹵20.4) mm / h before operation, (15.1 鹵5.9) mm / h after operation, (43.8 鹵18.6) mg / L before operation, and (8.9 鹵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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R687.4

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 Drexler;Kuzyk P R;Koo K;胡孔足;;抗生素骨水泥髖臼頂可增強(qiáng)人工髖關(guān)節(jié)感染翻修骨水泥占位器的穩(wěn)定性[J];臨床骨科雜志;2016年03期

2 張東霞;李國紅;侯照銀;張淑英;高桃;;人工髖關(guān)節(jié)置換術(shù)后患者感染病原菌分析[J];中華醫(yī)院感染學(xué)雜志;2016年06期

3 王景;徐瑞;張海鴻;;聚維酮碘溶液沖洗對骨科Ⅰ類切口術(shù)后感染的影響[J];臨床骨科雜志;2016年01期

4 劉剛;劉群;楊順杰;王溶;王坤;;人工髖關(guān)節(jié)置換術(shù)后感染的臨床特點(diǎn)與干預(yù)措施分析[J];中華醫(yī)院感染學(xué)雜志;2015年23期

5 郭學(xué)峰;伏鴻博;張可明;曹文;董強(qiáng);;髖關(guān)節(jié)置換患者術(shù)后醫(yī)院感染流行病學(xué)特征與危險(xiǎn)因素分析[J];中華醫(yī)院感染學(xué)雜志;2015年08期

6 趙智越;齊欣;楊晨;李叔強(qiáng);;大轉(zhuǎn)子延長截骨術(shù)在人工全髖關(guān)節(jié)翻修術(shù)中的臨床應(yīng)用進(jìn)展[J];中國骨傷;2015年03期

7 王北岳;周利武;張志強(qiáng);郭亭;趙建寧;;大臼杯在髖臼骨缺損患者的髖關(guān)節(jié)翻修術(shù)中的應(yīng)用[J];中國骨與關(guān)節(jié)雜志;2014年06期

8 吳穎娜;方歡;范曉玲;曾憲鐵;;骨科手術(shù)患者醫(yī)院感染的調(diào)查分析[J];中華醫(yī)院感染學(xué)雜志;2014年08期

9 沈?yàn)?王俏杰;蔣W，

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