Clinical analysis of one-stage THA combined with intra-articular injection of antibiotics in the treatment of infection af-ter internal fixation of hip fracture
Clinical analysis of one-stage THA combined with intra-articular injection of antibiotics in the treatment of infection af-ter internal fixation of hip fracture
张海耀 1李国庆 1汪洋 1纪保超 1周海康 1陈永杰 1曹力1
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作者信息
1. 新疆医科大学第一附属医院骨科,乌鲁木齐 830054
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摘要
目的 探讨一期全髋关节置换(total hip arthroplasty,THA)联合关节腔内注射抗生素治疗关节周围骨折内固定术后感染的临床疗效.方法 回顾性分析2013年1月至2021年1月新疆医科大学第一附属医院收治的因髋关节周围骨折内固定术后感染而行一期THA及术后联合关节腔内注射抗生素治疗的患者25例,男15例、女10例,年龄(61.52±13.06)岁(范围32～89岁),体质指数(24.04±3.84)kg/m2(范围18～34kg/m2).股骨颈骨折13例、转子间骨折6例、髋臼骨折4例、股骨近端骨折1例、髋臼骨折合并转子间骨折1例.对术前关节腔穿刺或术中抽取的关节液进行生化分析,同时送微生物培养及药敏试验.术中取出感染内固定并彻底清创后一期植入髋关节假体,术后根据细菌培养及药敏试验结果给予静脉和关节腔内注射敏感抗生素.根据Engh标准评价关节稳定性,采用髋关节Harris评分评估髋关节功能.结果 12例微生物培养结果呈阳性,其中4例为表皮葡萄球菌、2例为金黄色葡萄球菌、2例为大肠埃希菌、1例为阴沟肠杆菌、1例为铜绿假单胞菌、1例为纹带棒状杆菌、1例为表皮葡萄球菌与粪肠球菌混合感染.25例患者均获得随访,随访时间(56.64±26.38)个月(范围24～123个月).术后所有患者均采用静脉联合关节腔内注射敏感抗生素的治疗方案,其中1例于术后第20天出现窦道形成伴脓液流出,诊断为假体周围感染;其他24例感染得到控制,感染控制率为96％(24/25).术后除3例行髋关节翻修术外,末次随访时22例患者的髋关节Harris评分由术前的(26.69±13.47)分提升至(92.30±5.60)分(t=22.882,P＜0.001).根据Engh标准,假体均固定良好,无一例发生下沉、松动及骨溶解.术后出现髋关节脱位2例、下肢深静脉血栓形成2例、切口愈合不良1例、假体周围骨折1例.结论 采用一期THA联合关节腔内注射抗生素治疗髋关节周围骨折内固定术后感染可以获得良好的感染控制率和重建髋关节功能.
Abstract
Objective To evaluate the clinical efficacy of single-stage total hip arthroplasty(THA)combined with intra-articular antibiotic injection in managing postoperative infections following internal fixation of hip fractures.Methods A retro-spective analysis was conducted on 25 patients who underwent single-stage THA for infection following internal fixation of hip frac-tures from January 2013 to January 2021 at the Department of Joint Surgery,First Affiliated Hospital of Xinjiang Medical Universi-ty.The cohort comprised 15 males and 10 females,with an average age of 61.52±13.06 years(range,32-89 years)and an average body mass index of 24.04±3.84 kg/m2(range,18-34 kg/m2).The fractures included 13 femoral neck fractures,6 intertrochanteric fractures,4 acetabular fractures,1 proximal femoral fracture,and 1 combined acetabular and intertrochanteric fracture.Preopera-tive joint cavity puncture or intraoperative joint fluid extraction,biochemical analysis,microbial culture,and drug sensitivity tests were performed.During surgery,infected internal fixation devices were removed,and hip prostheses were implanted following thor-ough debridement.Postoperatively,patients received intravenous and intra-articular sensitive antibiotics based on bacterial cul-ture and drug sensitivity results.Joint stability was evaluated according to the Engh standard,and hip function was assessed using the Harris score.Results Microbial cultures were positive in 12 cases,identifying Staphylococcus epidermidis(4 cases),Staphy-lococcus aureus(2 cases),Escherichia coli(2 cases),Enterobacter cloacae(1 case),Pseudomonas aeruginosa(1 case),Corynebac-terium striatum(1 case),and a mixed infection of Staphylococcus epidermidis and Enterococcus faecalis(1 case).All 25 patients were followed for an average of 56.64±26.38 months(range,24-123 months).Intravenous and intra-articular antibiotic treatment was administered to all patients.One case experienced sinus tract formation and pus discharge on the 20th postoperative day,diag-nosed as periprosthetic infection,resulting in treatment failure,yielding an infection control rate of 96％(24/25).All patients dem-onstrated stable prosthesis fixation with no subsidence,loosening,or osteolysis.At the final follow-up,the Harris hip score im-proved significantly from a preoperative score of 26.69±13.47 to 92.30±5.60(t=22.882,P＜0.001).Complications included 2 cases of hip dislocation,2 cases of deep venous thrombosis in the lower extremities,1 case of poor wound healing,and 1 case of peripros-thetic fracture.Conclusion Single-stage THA combined with intra-articular antibiotic injection is effective in controlling infec-tions following internal fixation of hip fractures.This approach not only achieves a high infection control rate but also reconstructs hip joint function,resulting in satisfactory postoperative outcomes.
关键词
髋关节/骨折/骨折固定术,内/感染/关节成形术,置换,髋
Key words
Hip joint/Fractures,bone/Fracture fixation,internal/Infections/Arthroplasty,replacement,hip
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