万古霉素磷钙骨水泥在人工髋关节置换术后感染二期翻修术中作用.docVIP

万古霉素磷钙骨水泥在人工髋关节置换术后感染二期翻修术中作用 　 作者：王茂源，赵建宁，吴苏稼，包倪荣 【关键词】 人工髋关节 建立兔人工髋关节置换术后感染动物模型，探讨万古霉素磷酸钙骨水泥(VCMCPC)在人工全髋关节置换术后感染二期翻修术中的作用。［方法］新西兰大白兔60只，行人工髋关节置换术，术毕将含有1×108CFU耐甲氧西林表皮葡萄球菌株的明胶海绵即刻置入至左侧髋关节内，建立兔人工髋关节置换术后感染模型。术后4周清创，植入药物缓释材料，间隔6周后行二期置换术，观察万古霉素磷酸钙骨水泥在人工全髋关节置换术后感染二期翻修术中的作用。［结果］耐甲氧西林表皮葡萄球菌株接种后4周后所有动物的左侧髋关节均感染。二期再植和处死前各组感染率均下降，VCMCPC、VCMPMMA组感染率控制满意，而与对照组比较差异显著。［结论］载药CPC在人工髋关节置换术后感染二期翻修术中能明显降低感染复发率，可提高翻修成功率。 关键词：感染； 翻修； 关节成形术； 人工髋关 Abstract：［Objective］To study the effects vancomycinimpregnated calcium phosphate cement(VCMCPC) on the management of infection in the twostage revision for the infection after hip arthroplasty. ［Method］Gelatin sponge ,having methicillinresistant staphylococcus epidermidis(MRSE) of 1×108 CFU, was implanted in the left hip of 60 rabbits after the hip arthroplasty. The animal model of infected hip arthroplasty was established in rabbits. Debridement was performed four weeks later, the carrier material for VCM was implanted, and twostage revision arthroplasty was performed after 6 weeks. Effects of VCMCPC on the management of infection in the twostage revisions were observed.［Result］All left hip joints of animals were infected 4 weeks after MRSE.The rate of intbction decreased at replantation and before sacrificed and the infection control decreased significantly for group VCMCPC, VCMPMMA, as compared with that for the control group.［Conclusion］The drugimpregnated CPC can obviously decrease the rate of reinfection and increase the success rate of twostage revisions to treat the infection after the hip arthroplasty. Key words: Infection; Revision; Arthroplasty; Artifical hip joint 作为人工全髋关节置换术最严重的并发症，人工髋关节置换术后感染给病人带来无法承受的经济损失和精神打击。人工髋关节置换术后感染大多采用二期翻修术治疗。目前在人工髋关节置换术后感染二期翻修中应用最多的可植入药物缓释材料为聚甲基丙烯酸骨水泥(polymethylmethacrylate，PMMA)。磷酸钙骨水泥(calcium phosphate cement，CPC)，也称羟基磷灰石骨水泥(hydroxyapatite cement，HAC)，是一种新型的非陶瓷类人工骨材料，其作为药物缓释材料代替PMMA骨水泥应用于人工髋关节置换术后感染中的研究报道目前在国内外均尚未见到。为此作者对万古霉素磷酸钙骨水泥(vancomycin calcium phosphate cement，VCMCPC)在人工髋关节置换术后感染二期翻修中的作用进行