保留假体清创联合万古霉素局部灌注治疗全髋关节置换术后早期假体周围感染

doi:10.3760/cma.j.issn.1007-1245.2024.12.007

国际医药卫生导报 ›› 2024, Vol. 30 ›› Issue (12): 1966-1971.DOI: 10.3760/cma.j.issn.1007-1245.2024.12.007

保留假体清创联合万古霉素局部灌注治疗全髋关节置换术后早期假体周围感染

潘希安^1,2 张远金¹ 张国富¹ 李俊¹ 孙法瑞¹ 周定康³ 刘炳霞^2,4

¹黄石市中心医院（湖北理工学院附属医院）骨科，黄石　435000；²肾脏疾病发生与干预湖北省重点实验室，黄石　435000；³黄石市中心医院（湖北理工学院附属医院）手术麻醉科，黄石　435000；⁴黄石市中心医院（湖北理工学院附属医院）超声影像科，黄石　435000

收稿日期:2024-03-28 出版日期:2024-06-15 发布日期:2024-06-26
通讯作者: 刘炳霞，Email：benpaodeyupan@163.com
基金资助:
湖北省自然科学基金（2023AFB1071）；湖北理工学院校级科研项目（22xjz06W）

Clinical study of treatment of early prosthetic joint infection after total hip arthroplasty by debridement, antibiotics, and implant retention combined with local perfusion of vancomycin

Pan Xi'an^1,2, Zhang Yuanjin¹, Zhang Guofu¹, Li Jun¹, Sun Farui¹, Zhou Dingkang³, Liu Bingxia^2,4

¹Department of Orthopaedics, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi 435000, China; ²Hubei Key Laboratory of Kidney Disease Pathogenesis and Intervention, Huangshi 435000, China; ³Department of Operation, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi 435000, China; ⁴Department of Ultrasound Imaging, Huangshi Central Hospital, Affiliated Hospital of Hubei Polytechnic University, Huangshi 435000, China

Received:2024-03-28 Online:2024-06-15 Published:2024-06-26
Contact: Liu Bingxia, Email: benpaodeyupan@163.com
Supported by:
Natural Science Foundation of Hubei Province (2023AFB1071); Scientific Research Project of Hubei Polytechnic University (22xjz06W)

摘要/Abstract

摘要：

目的　探讨采用保留假体清创（DAIR）联合髋关节万古霉素局部灌注治疗全髋关节置换术（THA）后早期假体周围感染（PJI）的临床疗效。方法　本研究为回顾性分析。选取2018年7月至2022年5月在黄石市中心医院骨科行DIAR手术联合万古霉素关节腔局部灌注治疗的21例初次THA术后早期PJI患者。其中男性11例，女性10例，年龄（67.05±11.04）岁，均为初次THA术后3周以内并发PJI患者，随访时间（18.95±4.07）个月。手术由固定医疗团队完成，均为同一名医生主刀，术中均采用DIAR手术清创。术后2周内静脉滴注敏感抗生素，培养阴性者可选用万古霉素静脉滴注，每隔12 h静脉给药0.5 g，同时每隔2 d关节腔内使用万古霉素溶液灌注1次（方案为0.5 g万古霉素粉剂溶于60 ml生理盐水中，无菌条件下自灌洗管推入关节腔内），留取关节液并监测关节腔中药物浓度。静脉用药2周后改口服抗生素4周。比较术前及术后末次随访时的视觉模拟评分法（VAS）评分、Harris髋关节评分（HHS）及白细胞计数、血沉、C-反应蛋白水平。统计学方法采用配对ｔ检验。结果　21例患者中成功治疗19例、失败2例，感染总体控制率为90.5%（19/21）。术后末次随访时，VAS评分较术前下降［（1.62±0.67）分比（5.86±1.06）分］，HHS较术前提高［（77.92±7.72）分比（41.30±7.77）分］，白细胞计数、血沉、C-反应蛋白水平均较术前下降［（5.04±0.86）×10⁹/L比（10.62±1.02）×10⁹/L、（19.00±8.08）mm/h比（65.57±18.00）mm/h、（5.86±1.80）mg/L比（57.05±19.16）mg/L］，差异均有统计学意义（t=13.766、-16.159、17.654、12.610、12.570，均P<0.001）。结论　THA术后早期PJI患者采用DIAR手术联合万古霉素关节腔局部灌注治疗，可有效控制髋关节感染，缓解髋部疼痛。

关键词:

万古霉素, 局部灌注, 假体周围感染, 全髋关节置换术

Abstract:

Objective　To investigate the clinical efficacy of treatment of early prosthetic joint infection (PJI) after total hip arthroplasty (THA) with debridement, antibiotics, and implant retention (DAIR) combined with local perfusion of vancomycin into hip joint. Methods　A total of 21 patients with early PJI after the initial THA who received DAIR combined with local perfusion of vancomycin into their joint cavity in Department of Orthopaedics, Huangshi Central Hospital from July 2018 to May 2022 were enrolled. Among them, there were 11 males and 10 females, aged (67.05±11.04) years, all patients with PJI within 3 weeks after the initial THA, and the follow-up time was (18.95±4.07) months. The operation was performed by a fixed medical team, all operated by the same doctor, and DIAR surgery was used for debridement. Sensitive antibiotics were given intravenously within 2 weeks after surgery. The patients with culture negative could be given vancomycin intravenously, 0.5 g of which was given intravenously every 12 hours, and vancomycin solution was injected into the joint cavity once every 2 days (the protocol was 0.5 g of vancomycin powder dissolved in 60 ml of normal saline and pushed into the joint cavity by self-irrigating tube under sterile conditions). The joint fluid was retained and drug concentration in the joint cavity was monitored. Intravenous medication for 2 weeks was followed by oral antibiotics for 4 weeks. The Visual Analogue Scale (VAS) score and Harris Hip Score (HHS) were used to evaluate the pain and hip joint function. The white blood cell count (WBC), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were used as infection indicators, and differences in their levels before surgery and at the last follow-up were determined by paired t-test. Results　A total of 21 patients were enrolled; their age was (67.05±11.04) years old and 11 of them were male. All the patients were followed up for over 12 months, with a follow-up period of (18.95±4.07) months. The overall infection control rate was 90.5% (19 cases were cured and 2 cases failed). At the last follow-up, the VAS score was decreased compared with that before surgery [(1.62±0.67) points vs. (5.86±1.06) points], the HHS was increased compared with that before surgery [(77.92±7.72) points vs. (41.30±7.77) points], and the WBC, ESR, and CRP levels were all decreased compared with those before surgery [(5.04±0.86) ×10⁹/L vs. (10.62±1.02) ×10⁹/L, (19.00±8.08) mm/h vs. (65.57±18.00) mm/h, (5.86±1.80) mg/L vs. (57.05±19.16) mg/L], with statistically significant differences (t=13.766, -16.159, 17.654, 12.610, and 12.570, all P<0.001). Conclusion　DAIR combined with local perfusion of vancomycin into joint cavity can effectively control the hip joint infection and relieve the hip joint pain in patients with early PJI after THA.

Key words:

Vancomycin, Local perfusion, Prosthetic joint infection, Total hip arthroplasty

潘希安张远金张国富李俊孙法瑞周定康刘炳霞.

保留假体清创联合万古霉素局部灌注治疗全髋关节置换术后早期假体周围感染 [J]. 国际医药卫生导报, 2024, 30(12): 1966-1971.

Pan Xi'an, Zhang Yuanjin, Zhang Guofu, Li Jun, Sun Farui, Zhou Dingkang, Liu Bingxia.

Clinical study of treatment of early prosthetic joint infection after total hip arthroplasty by debridement, antibiotics, and implant retention combined with local perfusion of vancomycin [J]. International Medicine and Health Guidance News, 2024, 30(12): 1966-1971.

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保留假体清创联合万古霉素局部灌注治疗全髋关节置换术后早期假体周围感染

Clinical study of treatment of early prosthetic joint infection after total hip arthroplasty by debridement, antibiotics, and implant retention combined with local perfusion of vancomycin

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