摘要
目的探讨万古霉素-聚甲基丙烯酸甲酯(vancomycin-loadedpolymethylmethacrylate,VCM-PMMA)在兔人工股骨头感染一期翻修中的作用。方法24只日本大耳白兔,雌雄不拘,体重2.4～3.4kg。制备左侧人工股骨头置换术后感染模型,随机分为实验组和对照组(n=12),行清创和一期翻修手术,对照组以单纯PMMA固定,实验组以VCM-PMMA固定。术后即刻、4、8和12周摄X线片;术前及术后1、3、7d及2、4、8和12周8个时间点检测C-反应蛋白(Creactiveprotein,CRP)和血沉(erythrocytesedimentationrate,ESR);术后12周处死动物后,以细菌培养和罗丹明标记的兔抗表皮葡萄球菌免疫血清细菌染色检测感染治愈率,并行组织学观察。结果一期翻修术后,对照组有2只兔再次形成脓肿,实验组无脓肿再形成。关节活动度实验组较对照组高,且差异有统计学意义(P<0.05)。X线片示对照组有6个关节脱位,实验组有3个关节脱位。血清CRP对照组和实验组均于翻修术后1d显著升高(P<0.01),3d达高峰,于7d开始下降,对照组于术后第8周、实验组于术后第2周低于翻修前水平(P<0.01),实验组在术后4周接近正常水平。ESR两组均从翻修后3d开始升高,7d达高峰,对照组感染后一直居高不下,实验组于术后第4周低于翻修前水平。细菌检测显示,对照组和实验组分别有58.3%(7/12)和16.7%(2/12)发生再感染,翻修成功率分别为41.7%和83.3%。发生再感染的假膜组织光镜下可见大量慢性炎性细胞浸润,感染治愈者可见纤维细胞增生。结论兔人工股骨头置换术后感染一期翻修时应用VCM-PMMA固定假体,能显著提高翻修的成功率。
Objective To study the effect of vancomycin-loaded polymethylmethacrylate （VCM-PMMA） in the treatment of an experimental hemiprosthetic hip infection of rabbits. Methods The infected hemiprosthetic hip joints of the rabbits underwent debridement and one-stage revision arthroplasty. Requested by the ＂fixed＂ method, 24 rabbits were equally divided into 2 groups ： the control group and the experimental group. The prostheses were fixed with PMMA in the control group, but with VCM-PMMA in the experimental group. X-ray films were taken immediately after operation, and then 4, 8, and 12 weeks after operation. The C reactive protein （CRP） and the erythrocyte sedimentation rate （ESR） were measured before operation, then measured 1, 3, and 7 days after operation, and then 2, 4, 8, and 12 weeks after operation, i.e. , they were measured at the above 8 time points. All the rabbits were sacrificed 12 weeks later. The cure rate of the infection was determined by the blood culture for the corresponding bacteria and the Rhodamine-labeled anti-Staphylococcus epidermidis immune serum staining. Results The X-ray films revealed that 6 hemiprosthetic hip joints were dislocated in the control group, but 3 in the experimental group~ 58.3% and 16. 7% of the hemiprosthetic hip joints were reinfected in the control group and the experimental group, respectively. At 8 weeks in the control group, the serum CRP level decreased to a greater extent than that measured at the time of debridement, but in the experimental group just at 2 weeks （P〈0.01）. ESR remained elevated in the control group, but at 4 weeks ESR were significantly lowered compared with that measured at the time of debridement （P〈0. 01）. The test results for the pathogenic organisms revealed that the re-infection incidences were respectively 58.3% （7/12） and 16.7% （2/12） in the control group and the experimental group, with the successful revision rates of 41.7% and 83.3% respectively in the above 2 groups. The light microscopy revealed that there was a heavy infiltration by the inflammatory ceils in the re-infected tissues, but there was a proliferation of the fibrocytes in the tissues of the cured patients. Conclusion One-stage revision arthroplasty can significantly promote the control of the hemiprosthetic hip joint infection in rabbits by the use of VCM-PMMA.
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2006年第6期634-639,共6页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
万古霉素-聚甲基丙烯酸甲酯
人工髋关节
感染
一期翻修
Vancomycin-loaded polymethtylmethacrylate Hemiprosthetic hip joint Infection Onestage revision arthroplasty
