初次人工髋关节置换术后感染的诊断与治疗

初次人工髋关节置换术后感染的诊断与治疗作者：梅汉尧，索鹏，周永顶，高凌光

摘要：目的探讨初次人工髋关节置换术后感染的诊断和治疗方法。方法回顾性分析1998年1月至2004年3月收治的10 例初次人工髋关节置换术后感染的病例，其中男4 例，女6 例，平均68 岁(55～85 岁)。本院感染5 例，外院感染5 例。10 例患者均有患髋疼痛症状，4 例有窦道，6 例血沉增快，9 例C反应蛋白增高。术前窦道分泌物细菌培养，3 例阳性，1 例阴性。无窦道者术前行关节穿刺，细菌培养，3 例阳性，3 例阴性。4 例细菌培养阴性者，术中取标本培养仍为阴性。所有患者X线片有骨溶解、假体松动及反应骨形成等表现。治疗包括：保留假体清创2 例；一期翻修4 例，其中普通骨水泥固定2 例，抗生素骨水泥固定2 例；二期翻修4 例，取出假体，彻底清创，放置抗生素骨水泥团制备的临时假体间隔器，感染控制后，安放抗生素骨水泥固定的假体。结果 2 例保留假体清创者，术后感染复发，后改为取出假体旷置，二期翻修，术后未见感染复发。4 例一期翻修者，其中2 例抗生素骨水泥固定，术后未见感染复发，2 例普通骨水泥固定，术后感染复发，后改为取出假体旷置，二期翻修，术后感染未见复发。4 例二期翻修者，抗生素骨水泥固定，术后未见感染复发。所有患者均获随访，随访时间12～48个月，平均25个月，末次随访时，10 例患者均未见感染复发。结论初次人工髋关节置换术后感染的诊断和治疗均很困难，目前尚无特异性检查方法，需要对

患者所有的临床资料进行综合分析，才能做出正确的诊断，治疗方法选择应根据具体情况而定，以二期翻修较为理想。使用抗生素骨水泥固定可以提高控制感染的成功率。

关键词：关节成形术；置换；髋；感染；再手术

Diagnosis and Treatment of Infection after Primary Hip Arthroplasty

Abstract：Objective To investigate the methods of diagnosis and treatment for infection after primary hip arthroplasty. Methods From January 1998 to March 2004， 6 women and 4 men with a mean age of 68 years(range， 55～85 years) suffered from infection after primary hip arthroplasty were reviewed. Hip pain occurred in all 10 patients and fistula in 4 patients. Abnormal ESR was observed in 6 cases and the increased CRP in 9 patients. Three cases had positive culture result in secreta of fistula preoperatively. Arthrocentesis were performed preoperatively in 6 patients who had no fistula，and 3 cases had positive culture result in articular juice. There were 4 patients with negative culture result whose collections also had negative culture result during the debridement.

Radiography findings，such as osteolysis，loosening and endosteal scalloping，were presented on all 10 patients. Debridement and prosthesis maintenance were performed to 2 patients. Onestage revision were performed to 4 patients， among whom 2 prostheses with antibioticimpregnated cement and 2 prostheses with plain cement for fixation were chose. Two stage revision were performed to 4 patients. After thorough irrigation and debridement of the infected joint and the removal of the femoral and acetabular components， a temporary spacer with antibioticloaded beads of cement were inserted between the first and second stage. During the delayed reconstruction， the final prostheses were fixed with antibioticloaded cement after the infection was eliminated. Results Recurrent infection were found in 2 patients with prosthesis maintenance after debridement， none of recurrent infection were found in patients whose twostage revision were performed. None of recurrent infection were found in 2 cases of onestage revision and 4 cases of twostage revision whose prostheses were fixed with antibioticloaded cement. Recurrent infection were found in 2 cases of onestage revision whose prostheses were fixed with plain cement， none of recurrent infection were found in 2 patients whose twostage revision were performed. All patients