中国修复重建外科杂志

中国修复重建外科杂志

人工全髋关节置换术治疗髋关节感染后遗关节畸形的疗效研究

查看全文

目的 探讨人工全髋关节置换术(total hip arthroplasty,THA)治疗髋关节感染后遗关节畸形患者,其髋关节功能恢复及感染再发的情况。 方法 回顾 2010 年 6 月—2017 年 5 月采用 THA 治疗的 31 例(31 髋)髋关节感染后遗关节畸形患者临床资料。男 18 例,女 13 例;年龄 20~71 岁,平均 46.1 岁。化脓性感染 17 例,结核性感染 9 例,感染性质不详 5 例;感染至治愈时间 6~25 个月,平均 13.9 个月。明确感染源患者感染治愈至 THA 时间为 6~58 年,平均 23.4 年。根据 Kim 分型标准:Ⅰ型 12 例,Ⅱ型 9 例,Ⅲ型 10 例。关节发育异常后遗骨关节炎 21 例,病理性脱位 7 例,髋关节强直 3 例。术侧下肢缩短 0.5~5.6 cm,平均 2.9 cm。术后通过体征及实验室检查评估感染情况,摄髋关节 X 线片评估髋关节骨性结构、是否有感染性病灶及测量下肢长度,Harris 评分评估髋关节功能。 结果 患者均获随访,随访时间 10~63 个月,平均 34 个月。术中留取组织细菌培养均为阴性。术后切口均Ⅰ期愈合;术后 1 例发生坐骨神经刺激症状,1 例关节后脱位。随访期间均无感染再发。末次随访时,髋关节功能参照 Harris 评分获优 8 例、良 19 例、中 4 例,优良率达 87%。X 线片复查示无斑片状骨密度降低及点状硬化,无透亮区。与健侧相比,5 例术侧肢体短缩,长度为 0.4~1.3 cm,平均 0.6 cm;患者均未见明显跛行,无肢体不等长主观感觉。 结论 髋关节感染后遗关节畸形患者经评估确定为感染静止期后行 THA,可以获得良好的髋关节功能,感染再发风险低。

Objective To evaluate hip function and reinfection of the patients with hip infection sequelae after total hip arthroplasty (THA) treatment. Methods A clinical data of 31 patients (31 hips) with hip infection sequelae who were treated with THA between June 2010 and May 2017. There were 18 males and 13 females, with an average age of 46.1 years (range, 20-71 years). There were pyogenic infection in 17 cases, tuberculous infection in 9 cases, and unknown source of infection in 5 cases. The average time from infection to cure was 13.9 months (range, 6-25 months). The average time from cure to operation was 23.4 years (range, 6-58 years) for patients with confirmed source of infection. According to Kim classification, 12 cases were rated as typeⅠ, 9 as typeⅡ, and 10 as type Ⅲ. There were 21 cases of osteoarthritis after dysplasia, 7 cases of pathologic dislocation, and 3 cases of hip ankylosis. After operation, the infection was assessed by physical signs and laboratory tests; X-ray film of the hip was taken to assess the skeletal structure of the hip and infectious lesion; the length of the lower limb was measured, and the function of the hip joint was evaluated by Harris score. Results All patients were followed up 10-63 months (mean, 34 months). The result of bacterial culture was negative. The incisions healed by first intention. The sciatic nerve stimulation occurred in 1 case and posterior dislocation of the joint occurred in 1 case after operation. There was no recurrence of infection and no aseptic loosening of the prosthesis. According to Harris score, the function of the hip was rated as excellent in 8 cases, good in 19 cases, and fair in 4 cases at last follow-up; and the excellent and good rate of hip joint function was 87%. X-ray films showed no patchy bone density reduction, spot hardening, or light areas. The length of affected limb was not fully equal with the unaffected limb in 5 cases, and the difference between two sides ranged from 0.4 to 1.3 cm (mean, 0.6 cm). At last follow-up, all patients had no obvious claudication or sensation of unequal length. Conclusion THA can obtain satisfactory hip function and has low risk of infection recurrence for the patients with hip infection sequelae, who were assessed as the hip infection in a dormant state.

关键词: 人工全髋关节置换术; 髋关节感染; 髋关节畸形; 关节功能

Key words: Total hip arthroplasty; hip infection; deformity of hip joint; function of joint

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Craigen MA, Watters J, Hackett JS. The changing epidemiology of osteomyelitis in children. J Bone Joint Surg (Br), 1992, 74(4): 541-545.
2. Nunn TR, Cheung WY, Rollinson PD. A prospective study of pyogenic sepsis of the hip in childhood. J Bone Joint Surg (Br), 2007, 89(1): 100-106.
3. 康鹏德, 裴福兴, 王坤正. 感染后髋关节的初次人工关节置换. 中华骨科杂志, 2005, 25(7): 404-408.
4. 谭钢, 罗磊, 杨静, 等. 3664例全髋关节置换术相关危险因素分析. 中国矫形外科杂志, 2011, 19(17): 1431-1434.
5. Park YS, Moon YW, Lim SJ, et al. Prognostic factors influencing the functional outcome of total hip arthroplasty for hip infection sequelae. J Arthroplasty, 2005, 20(5): 608-613.
6. Dudkiewicz I, Salai M, Chechik A, et al. Total hip arthroplasty after childhood septic hip in patients younger than 25 years of age. J Pediatr Orthop, 2000, 20(5): 585-587.
7. Kim YH, Oh SH, Kim JS. Total hip arthroplasty in adult patients who had childhood infection of the hip. J Bone J Surg (Am), 2003, 85(2): 198-204.
8. Kim YH. Total arthroplasty of the hip after childhood sepsis. J Bone Joint Surg (Br), 1991, 73(5): 783-786.
9. Masonis JL, Patel JV, Miu A, et al. Subtrochanteric shortening and derotational osteotomy in primary total hip arthroplasty for patients with severe hip dysplasia: 5-year follow-up. J Arthroplasty, 2003, 18(3 Suppl 1): 68-73.
10. Gao X, He RX, Yan SG. Total hip arthroplasty for patients with osteoarthritis secondary to hip pyogenic infection. Chin Med J (Engl), 2010, 123(2): 156-159.
11. Manzotti A, Rovetta L, Pullen C, et al. Treatment of the late sequelae of septic arthritis of the hip. Clin Orthop Relat Res, 2003, (410): 203-212.
12. 卢宏章, 朱天岳, 柴卫兵, 等. 感染后关节的初次人工关节置换术. 中华骨科杂志, 2004, 24(4): 203-206.
13. Hampton BJ, Harris WH. Primary cementless acetabular components in hips with severe developmental dysplasia or total dislocation. A concise follow-up, at an average of sixteen years, of a previous report. J Bone Joint Surg (Am), 2006, 88(7): 1549-1552.
14. 张亮, 李玉军, 郭晓忠, 等. 人工全髋关节置换术治疗髋关节感染继发骨关节炎的中期疗效. 中国修复重建外科杂志, 2014, 28(2): 218-222.
15. Farrell CM, Springer BD, Haidukewych GJ, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg (Am), 2005, 87(12): 2619-2625.
16. 吕宁. 闭合复位空心钉内固定和人工全髋关节置换治疗股骨颈骨折的临床疗效分析. 大连: 大连医科大学, 2013.
17. Hardinge K, Cleary J, Charnley J. Low-friction arthroplasty for healed septic and tuberculous arthritis. J Bone Joint Surg (Br), 1979, 61-B(2): 144-147.
18. 李满江, 王智勇, 张志强. 血清降钙素原在诊断关节置换术后早期感染的临床意义. 中华骨与关节外科杂志, 2015, 8(6): 546-548.
19. Greidanus NV, Masri BA, Garbuz DS, et al. Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg (Am), 2007, 89(7): 1409-1416.
20. Nazem K, Motififard M, Yousefian M. Variations in ESR and CRP in total knee arthroplasty and total hip arthroplasty in Iranian patients from 2009 to 2011. Adv Biomed Res, 2016, 5: 148.