Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty
Mechanical complications with one hundred and thirty eight (antibiotic-laden) cement spacers in the treatment of periprosthetic infection after total hip arthroplasty
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DOI：
10.1007/s00264-014-2636-z
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发表时间：
2015-05-01
影响因子：
2.7
通讯作者：
Kappe, Thomas
中科院分区：
文献类型：
--
作者：
Faschingbauer, Martin;Reichel, Heiko;Kappe, Thomas
目的全髋关节置换术后假体周围感染是一种严重的并发症。临时插入含抗生素的水泥隔离剂的两阶段方案是慢性感染的金标准治疗(Clinics (Sao Paulo) 62:99- 108,2007；中华骨科杂志，2004；J关节外科杂志，1999；临床骨科杂志447:1848-1858,2009；J关节外科杂志，2005；中华关节外科杂志（英文版）；2009；中华骨科杂志，2011；嘻哈Int 20:26-33, 2010；关节外科杂志，2009；[J] .中华骨关节外科杂志，2009(5):544 - 551。然而，一些作者（国际医学杂志6(5):265- 73,2009）报告使用垫片的机械并发症发生率超过50%。因此，本研究的目的是确定(1)在治疗假体周围髋关节感染时，与封闭关节部分承重垫片相关的机械并发症和(2)可能的影响因素。方法在2000年至2011年期间，138例患者接受了含抗生素的水泥间隔剂，作为两阶段方案的一部分。记录并发症的总体频率（间隔器骨折、脱位、股骨骨折伴封闭间隔器、间隔器骨折伴脱位、骨盆突出）。分析了潜在的影响因素（“模具垫片”与手工垫片，Steinmann销作为内骨骼，在垫片中添加万古霉素）。结果患者一期手术时平均年龄为69.3±10.5岁。总体而言，138例患者中有27例（19.6%）出现上述并发症之一。间隔性骨折12例（8.7%），脱位12例（8.7%）。还有一例假体周围股骨骨折伴原位垫片，一例脱位伴同步垫片骨折，一例骨盆突出（各占0.7%）。结论：我们的数据显示，闭合斯坦曼针的模具垫片的总并发症率为13.2%。一些作者报道的机械性并发症发生率超过50%，不能证实。因此，我们建议使用带封闭斯坦曼针的模具垫片作为内骨架，以尽量减少并发症的发生率。
Purpose Periprosthetic infection after total hip arthroplasty is a devastating complication. A two-stage protocol with the temporary insertion of an antibiotic-laden cement spacer is the gold standard treatment for chronic infections (Clinics (Sao Paulo) 62:99-108, 2007; Clin Orthop Relat Res 427:37-46, 2004; J Arthroplast 14:175-181, 1999; Clin Orthop Relat Res 467:1848-1858, 2009; J Arthroplast 20:874-879, 2005; J Arthroplast 24: 607-613, 2009; Clin Orthop Relat Res 469:1009-1015, 2011; Hip Int 20:26-33, 2010; J Arthroplast 24:1051-1060, 2009; J Bone Joint Surg Br 91:44-51, 2009). Some authors, however (Int J Med Sci 6(5):265-73, 2009), report mechanical complication rates with spacers in excess of 50 %.Therefore, the aim of this study is to determine (1) the mechanical complications associated with enclosed articulating partial load-bearing spacers when treating periprosthetic hip infections and (2) possible factors of influence.Methods Between 2000 and 2011, 138 patients received an antibiotic-laden cement spacer as part of a two-stage protocol. The overall frequency of complications (spacer fracture, dislocation, femoral fracture with enclosed spacer, spacer fracture with dislocation, protusion into the pelvis) was recorded. Potential influencing factors ('mould spacer' vs. handmade spacer, Steinmann pins as an endoskeleton, addition of vancomycin into the spacer) were analysed.Results The mean age at the time of the first stage operation was 69.3 +/- 10.5 years. Overall, 27 of 138 patients suffered one of the above-mentioned complications (19.6 %). Spacer fracture occurred in 12 cases (8.7 %) and dislocation in another 12 (8.7 %). There was also one periprosthetic femoral fracture with a spacer in situ, one dislocation with a simultaneous spacer fracture, and one protrusion into the pelvis (0.7 % each).Conclusions Our data revealed an overall complication rate of 13.2 % with a mould spacer enclosing a Steinman pin. The mechanical complication rate of over 50 % reported by some authors cannot be confirmed. As a consequence, we recommend using a mould spacer with an enclosed Steinman pin as an endoskeleton to minimize the complication rate.