老年人工关节感染患者留置骨水泥间隔器的临床疗效分析

doi:10.3877/cma.j.issn.2096-0263.2019.06.001

目的

评估老年人工关节感染患者采用二期翻修治疗，第一阶段术后留置骨水泥间隔器的临床疗效。

方法

回顾性收集福建医科大学附属第一医院有完整随访资料的留置骨水泥间隔器的老年人工关节感染患者17例，男性8例，女性9例，患者年龄60~88岁，平均年龄（73±8）岁；髋关节11例，膝关节6例；16例检出病原菌；15例使用关节型间隔器，2例使用非关节型间隔器，留置骨水泥间隔器的时间为6~69个月。记录患者生存状况、术后感染控制、功能恢复以及再次手术情况；采用Harris评分及KSS评分评价末次随访时的关节功能，并采用疼痛视觉模拟评分（VAS）评价关节疼痛情况。

结果

17例患者均获得随访，随访时间6~69个月，平均（28±15）个月。健在患者16例（16/17，94.1%），已故患者1例（1/17，5.9%）。15例健在患者感染控制（15/16，93.7%），1例（1/16，6.3%）患者因感染持续而移除间隔器，4（4/17，23.6%）例患者术后进行额外清创手术，2例（2/17，11.8%）出现并发症。除去已故及关节旷置患者外，其余15例患者末次随访时髋关节Harris评分为（82±4）分；膝关节KSS评分为（79.8±2.6）分；VAS评分为（1.0±0.9）分（0~4分）。

结论

对于老年人工关节感染患者，彻底清创后留置关节型骨水泥间隔器感染控制高、功能恢复良好。

关键词: 老年人, 感染, 人工关节, 间隔器, 留置

Objective

To evaluate the clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection.

Methods

Seventeen retention prosthetic bone cement spacers elderly patients with periprosthetic joint infection with complete data were included in the present study. There were 8 males and 9 females, aged 60-88 years, average age was (73±8) years old, including 11 hips, 6 knee joints, thus 16 pathogens were detected, 15 cases used joint spacers, 2 cases used non-articular spacers. The time for indwelling the cement spacer was 6 to 69 months. Patient survival, postoperative infection control, functional recovery, and reoperation were recorded. Harris score and KSS score were used to evaluate joint function at the last follow-up, and pain visual analogue scale (VAS) was used to evaluate joint pain.

Results

All patients were followed up for 6 to 69 months with an average of (28±15) months. There were 16 patients (16/17, 94.1%) and 1 patient (1/17, 5.9%). The remaining 15 patients had infection control (15/16, 93.7%), 1 patient (1/16, 6.3%) had spacers removed due to persistent infection, and 4 (4/17, 23.6%) patients had additional postoperative debridement operation, 2 (2/17, 11.8%) cases had complications. Except for the patients with decomposed and articular dislocation, the other 15 patients had a Harris score of (82±4) at the last follow-up, the KSS score of the knee was (79.8±2.6), the VAS score was (1.0±0.9)(0 to 4 points).

Conclusion

Retention bone cement spacers can be obtained satisfactory infection control and functional recovery after debridement in elderly patients with periprosthetic joint infection.

Key words: Aged, Infection, Joint prosthesis, Spacers, Retention

表1 老年人工关节感染患者人口学特征及随访结果

病例	性别	年龄（岁）	病原菌	关节	随访时间（月）	Harris	KSS	VAS	结局
1	男	60	金黄色葡萄球菌	髋	47	75	-	1	成功
2	男	67	MRSE	髋	40	-	-	-	死亡
3	女	67	铜绿假单孢菌	髋	41	78	-	1	成功
4	女	88	MRSA	髋	27	83	-	0	成功
5	男	61	金黄色葡萄球菌	膝	27	-	84	0	成功
6	男	82	表皮葡萄球菌	膝	31	-	80	0	成功
7	女	77	表皮葡萄球菌	髋	16	79	-	1	成功
8	女	80	科氏葡萄球菌	膝	69	-	76	2	成功
9	男	79	金黄色葡萄球菌	髋	18	-	-	4	失败
10	女	65	微小单孢菌属	髋	15	85	-	0	成功
11	女	68	粪肠球菌	膝	14	-	78	1	成功
12	女	76	表皮葡萄球菌	髋	32	88	-	1	成功
13	男	80	表皮葡萄球菌	膝	34	-	82	2	成功
14	女	78	无乳链球菌	髋	30	79	-	1	成功
15	男	62	未检出	髋	24	90	-	1	成功
16	女	70	金黄色葡萄球菌	膝	6	-	79	0	成功
17	男	82	脓肿分支杆菌	髋	8	87	-	0	成功

表1 老年人工关节感染患者人口学特征及随访结果

病例	性别	年龄（岁）	病原菌	关节	随访时间（月）	Harris	KSS	VAS	结局
1	男	60	金黄色葡萄球菌	髋	47	75	-	1	成功
2	男	67	MRSE	髋	40	-	-	-	死亡
3	女	67	铜绿假单孢菌	髋	41	78	-	1	成功
4	女	88	MRSA	髋	27	83	-	0	成功
5	男	61	金黄色葡萄球菌	膝	27	-	84	0	成功
6	男	82	表皮葡萄球菌	膝	31	-	80	0	成功
7	女	77	表皮葡萄球菌	髋	16	79	-	1	成功
8	女	80	科氏葡萄球菌	膝	69	-	76	2	成功
9	男	79	金黄色葡萄球菌	髋	18	-	-	4	失败
10	女	65	微小单孢菌属	髋	15	85	-	0	成功
11	女	68	粪肠球菌	膝	14	-	78	1	成功
12	女	76	表皮葡萄球菌	髋	32	88	-	1	成功
13	男	80	表皮葡萄球菌	膝	34	-	82	2	成功
14	女	78	无乳链球菌	髋	30	79	-	1	成功
15	男	62	未检出	髋	24	90	-	1	成功
16	女	70	金黄色葡萄球菌	膝	6	-	79	0	成功
17	男	82	脓肿分支杆菌	髋	8	87	-	0	成功

图5 髋关节间隔器脱位

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Clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection

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Clinical efficacy of retention prosthetic bone cement spacers in elderly patients with periprosthetic joint infection