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二期翻修治疗人工全髋关节置换术后感染2-5年随访结果

Management of 2 to 5 Years Follow-up of the Infection after Total Hip Arthroplasty with Two-stage Revisions

作者: 专业:骨科 导师:郑稼 年度:2010 学位:硕士  院校: 郑州大学

Keywords

Total hip arthroplasty, Infection, Two-stage revision

        背景随着近年来人们寿命的增加,交通事故及外伤的频发以及各种先天性疾病发病率的增加,人工全髋关节置换术(Total hip arthroplasty, THA)治疗各种髋部疾病和创伤在我国现已得到广泛的开展。然而术后感染是THA最严重的并发症,往往造成手术失败,增加患者的生理和心理痛苦及经济负担。THA‘后感染治疗难度相当大,多选择抗生素治疗、清创关节灌洗术、一期翻修术、二期翻修术等,对于晚期感染,二期翻修术由于其众多的优越性被公认为是治疗的“金标准”。二期翻修术后的随访报告仍然较少,无法确切了解术后感染复发和关节功能情况。目的分析18例人工全髋关节置换术后感染行二期翻修术治疗后2-5年随访结果,评价二期翻修术治疗人工全髋关节置换术后感染的疗效,总结治疗经验,为临床工作提供参考。材料与方法对2004年7月-2008年7月间于我科确诊为人工全髋关节置换术后感染并行二期翻修术的18例患者进行随访,随访时限为2-5年,平均3年,并获得完整随访资料。年龄46岁-72岁,平均69.8岁,其中男10例(11髋),女8例(8髋),左髋10例,右髋8例,双髋1例。初次手术原因:股骨头缺血性坏死12例,股骨颈骨折5例,类风湿性关节炎1例,均为初次置换后感染。所有患者均一期彻底清创,置入抗生素骨水泥临时假体旷置,平均间隔5.8个月(4月-12个月),感染控制后行二期翻修术。术后定期随访获得完整随访资料,采用Harris评分、实验室检查、影像学检查评价疗效。结果全部病例均无感染复发,感染控制率达100%。Harris评分平均为87.2分(71分-97分),较术前的平均31.1分(12分-39分)明显改善。实验室检查及影像学检查满意,全部病例未发生并发症。结论二期翻修手术是治疗人工全髋关节置换术后感染的有效手段,在感染控制和功能恢复方面均较满意。
    BackgroundWith the gradual increase of people’s natural life,the traffic accidents,the traumatism and the congenital disease,today in China many doctors use the total hip arthroplasty(THA) to solve hip disease and traumatism.Postoperative infection after THA is the most severe complication resulting in failure of the procedure to increase the patient’s physical and psychological suffering and economic burden.The treatment of infection after THA is very difficult.We can use antibacterial therapy,one-stage revision,two-stage revision and so on.Two-stage revision is usually used to solve late infection.It become recognized as the gold standard of the infection after THA.However there is a lack of the management to estimate the re-infection and functional outcome.ObjectiveWe want to present the experience with two-stage revision in the management of the infected hip arthroplasty to evaluate this method by analyze of the 18 cases. MethodsBetween July,2004 to July 2008,a total of 19 hips in 18 patients were performed the revisions of the total hip replacement.The reason was infection after THA.That follow-up after revision was 2 to 5 years and an average time of 3 years.Among them,10 were male(11 hip) and 8 were female(8 hip),with there ages ranging from 46 to 72 and an average age of 69.8 years.The arthroplasty in 18 patients,10 left,8 right and 1 bilateral.The reasons of primary replacement include avascular necrosis of the femoral head(12),fracture of femoral neck(5),rheumatoid arthritis(1).All of them were infected after primary total hip arthroplasty.First 18 patients were performed thorough debridement,and then implanted antibiotic-loaded cement prosthesis as an interim spacer.When the infection was cured we could perform two-stage revision.The interval was 4 months to 12 months and an average time of 5.8 months.ResultNone of 18 patients had reinfection..The preoperative Harris Hip Score averaged 31.1(12-39) points.The postoperative Harris Hip Score averaged 87.2(71-97) points, up by 56.1 points over the preoperative.The laboratory investigation and imaging examination showed normally.ConclusionTwo-stage revision is an effective method to treat postoperative infection after total hip arthroplasty.It has high rate of eradication of the infection and satisfactory postoperative functional result.
        

二期翻修治疗人工全髋关节置换术后感染2-5年随访结果

中文摘要4-6
Abstract6-7
引言10-12
资料和方法12-15
结果15-16
讨论16-29
结论29-30
参考文献30-33
附图表33-37
综述一37-52
综述二52-58
致谢58-59
个人简历59
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