中国组织工程研究

中国组织工程研究 ›› 2011, Vol. 15 ›› Issue (43): 8118-8123.doi: 10.3969/j.issn.1673-8225.2011.43.034

• 骨与关节综述 bone and joint review • 上一篇    下一篇

全髋关节置换后假体周围感染的研究进展

李飞龙，曾意荣   

  1. 广州中医药大学第一附属医院关节一科，广东省广州市  510405
  • 收稿日期:2011-08-08 修回日期:2011-09-02 出版日期:2011-10-22 发布日期:2011-10-22
  • 通讯作者: 曾意荣，博士，主任医师，广州中医药大学第一附属医院关节一科， 广东省广州市 510405
  • 作者简介:李飞龙★，男，1986年生，湖南省益阳市人，汉族，广州中医药大学在读硕士，主要从事髋膝关节疾病的研究。

Process concerning the periprosthetic infection after total hip replacement

Li Fei-long, Zeng Yi-rong   

  1. First Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou  510405, Guangdong Province, China
  • Received:2011-08-08 Revised:2011-09-02 Online:2011-10-22 Published:2011-10-22
  • Contact: Zeng Yi-rong, Doctor, Chief physician, First Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China
  • About author:Li Fei-long★, Studying for master’s degree, First Department of Joint Surgery, First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, Guangdong Province, China dragonlfl@126.com

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摘要：

背景：全髋关节置换后发生的假体周围感染常导致置换失败并需行翻修手术。
目的：综合近几年文献探讨全髋关节置换术后感染机制，以及其诊断与治疗的进展。
方法：应用计算机检索1990-01/ 2010-12 Pubmed数据库、1970-01-01/ 2010-12-31 SpringerLink数据库相关文章， 检索词为“total hip arthroplasty， infection”共检索到文献2 109篇， 并参阅其他相关的著作及高影响因子的相关文献， 最终纳入符合标准的文献29篇。
结果与结论：假体表面生物膜的形成是微生物难以消除的主要原因。耐药菌的出现及多微生物的感染比例正逐渐上升， 及时而正确的诊断对其预后影响很大， 但尚无统一诊断的金标准， 每种诊断手段都有其优缺点， 必须综合考虑，白细胞介素6因为其廉价无创及高敏感和特异性，正逐渐成为研究热点。治疗目前包括单独抗生素治疗、清创保留假体、一期翻修、二期翻修、关节融合及截肢等方法。抗生素的预防是非常重要的， 抗生素丙烯酸骨水泥假体技术(PROSTALAC)， 正逐渐被越来越多的术者接受。但是每一种治疗方案的选择应根据每一患者其具体病情需要选择合适的治疗方案。

关键词: 全髋关节置换, 假体, 感染, 诊断, 治疗

Abstract:

BACKGROUND: Periprosthetic infection after total hip replacement usually results in surgery failure and needs a second operation.
OBJECTIVE: To explore the pathogenesis, diagnosis and treatment of periprosthetic infection after total hip replacement by reviewing and summarizing articles published in recent years.
METHODS: A computed-based online search of Pubmed database was performed by using the key words of “total hip arthroplasty, infection” for manuscripts published from January 1990 to December 2010 and of those in SpringerLink database between January 1, 1970 and December 31, 2010. A total of 2 109 manuscripts were retrieved. Moreover, related book or manuscripts that published by high-impact journals were included. Totally, 29 manuscripts were included.
RESULTS AND CONCLUSION: The formation of biofilms on the surface of prosthesis is the main cause for hardly eradicated. Resistant bacteria and polymicrobial infection seems to be an increasing tendency. A correct diagnosis as soon as possible is very important to prognosis. However, without a gold-standard way, each mean has advantages and shortages, and comprehensive considerations are necessary. Interleukin-6 seems a good choice for its inexpensive, non-invasive and a high sensitivity and specificity, which has aroused increasing attention. The antibiotics only, debridement with retention, one-stage replacement, two-stage replacement, joint arthrodesis, even amputation, are used to treat infection after total hip replacement. Prophylactic antibiotics are important to prevent infection. Antibiotic-loaded acrylic cement seems to be reliable and accept for more and more patients. However, each option must be selected according to the presence of infection individually.

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