감염성 인공 고관절의 치료
Treatment of Infected Total Hip Arthroplasty
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목적: 감염성 인공 고관절 환자에서 시행된 2단계 재치환술의 치료 결과를 분석하였다. 대상 및 방법: 1988년부터 2005년까지 감염성 인공 고관절로 본원에서 2단계 재치환술을 시행 받고 2년 이상 추시된 24명(남 자 18명, 여자 6명)을 대상으로 수술 전후의 임상 증상, 방사선학적 결과, 혈액 검사 등을 비교 분석하였다. 이 중 8예는 안정적 인 대퇴 스템은 그대로 두고 비구 컵만 제거한 후 항생제 혼합 시멘트 비구부 성형술을 1단계 수술에서 시행하고 2단계 수술에 서 비구 컵만 재치환하였다. 결과: 1단계 수술에서 균이 배양된 경우는 19예였고, Staphylococcus aureus가 14예로 가장 많았다. 2단계 재치환술 후 평균 추시 기간은 8.2년이었고, 최종 추시 Harris hip score는 88.4로 향상되었고, 방사선학적 골용해 소견은 5예에서 발생하였으며, 1예에서 possible loosening이 관찰되었다. ESR (mm/hr)과 CRP (mg/L)는 43.8/14.2에서 17.9/8.3으로 낮아졌고, 2단계 재 치환술 후 2예에서 감염이 재발하여 감염 치유율은 91.7%(22/24)였다. 결론: 감염성 인공 고관절의 치료에서 2단계 재치환술은 감염 재발이 적은 성공적인 결과를 보였다.
Abstract
Purpose: To analyze the effectiveness of a two-stage revision surgery for an infected total hip arthroplasty. Materials and Methods: Between 1988 and 2005, twenty-four patients (24 hips, 18 males, 6 females) with documented infection of total hip arthroplasty were reviewed and followed for at least two years postoperatively. The preoperative and postoperative clinical and radiologic findings and blood laboratory work were compared. Eight arthroplasty cases were performed through retention of the femoral stem and removal of the acetabular cup with cementing by impregnated antibiotics in the first stage of the operation, and subsequent acetabular cup revision in the second stage of the operation. Results: After the first stage of the operation, infectious organisms were cultured in 19 patients, and isolated Staphylococcus aureus was cultured in 14 patients. The mean follow-up period was 8.2 years, and the average Harris hip score improved to 88.4 points at last follow-up. Radiologic osteolysis was noted in 5 cases, and possible loosening was demonstrated in 1 case. The erythrocyte sediment rate (mm/hr) and C-reactive protein (mg/L) were 43.8/14.2 preoperatively and 17.9/8.3 postoperatively. There were 2 recurrences of infection, for an eradication rate of 91.7% (22 of 24). Conclusion: Two-stage revision for an infected total hip arthroplasty proved to be an excellent method with a high eradication rate.
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