大腿骨頚部/転子部骨折・骨接合術後化膿性股関節炎に対する二期的セメント人工股関節置換術の検討

Two-stage Primary Total Hip Arthroplasty with a Cemented Prosthesis for Infected Hips after Proximal Femoral Osteosynthesis

　大腿骨頚部/転子部骨折・骨接合術後の化膿性股関節炎に対し，感染鎮静と機能再建を目的として，抗菌薬含有セメントを用いた二期的セメント人工股関節置換術を7例7股に行った．全症例で最終日常生活動作は改善したが，感染再燃1股と脱臼3股を認めた．感染再燃例は二期的再置換，脱臼例2股は保存的加療，脱臼例1股はステム再置換を施行した．最終的に感染鎮静化は保たれ，機能再建可能であった．骨接合術後の化膿性股関節炎の場合は，骨癒合の有無，骨折部位，骨接合術の展開範囲などが，再建方法に影響すると考えられた．

　Between September 2000 and March 2011, 7 hips of 7 patients (5 men and 2 women；mean age, 67.6 years) who developed a postoperative site infection after proximal femoral osteosynthesis were treated by two-stage primary total hip arthroplasty (THA) with antibiotic-loaded acrylic cement (ALAC).　The mean duration of clinical follow-up was 64.3 months (range：6 to 123 months).　Although there was improvement in activities of daily living in all 7 cases, postoperative dislocation developed in 3 cases and recurrent deep infection in 1 case.　Two of the dislocations were successfully managed by closed reduction, and the third dislocation was successfully managed after revision of the femoral component.　An additional two-stage revision was necessary in the case of recurrent deep infection.　None of the patients had experienced an additional dislocation or deep infection as of the last follow-up examination.　We concluded that several factors affect the treatment strategy for infection after proximal femoral osteosynthesis：bone union, fracture site, and method of osteosynthesis.