老年人股骨颈骨折半髋关节置换术后早期感染危险因素分析  

Risk factors for early infection after hemiarthroplasty in elderly patients with femoral neck fracture

作　　者：杨登峰[1] 张勇智[1] 阮文辉[1] YANG Deng-feng;ZHANG Yong-zhi;RUAN Wen-hui(Department of Osteoarticular Traumatology,Hanzhong Central Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市中心医院骨关节创伤科

出　　处：《实用老年医学》2020年第1期46-49,共4页Practical Geriatrics

摘　　要：目的探讨老年股骨颈骨折病人在接受半髋关节置换术后早期发生关节假体周围感染的危险因素。方法本研究回顾性纳入了2012~2017年在我院接受半髋关节置换术的老年股骨颈骨折(AO/OTA 31-B)病人。评估病人术后4周内是否出现关节假体周围感染征象,并确定影响关节假体周围感染的独立危险因素和诊断阈值。结果本研究共纳入390例病人,其中18例病人在术后早期发生关节假体周围感染,其发生率为4. 6%。单因素分析提示BMI升高、术前CRP升高、手术时间延长、合并糖尿病、糖皮质激素使用史等与关节假体周围感染相关(P<0. 05)。通过ROC曲线证实BMI、术前CRP和手术时间对关节假体周围感染的诊断阈值分别为25. 3、14. 2 mg/L和75. 0 min。多因素Logistics回归分析提示BMI> 25. 3 (OR=2. 232,95%CI:1. 514~3. 465,P<0. 001)、CRP>14. 2 mg/L(OR=1. 438,95%CI:1. 201~1. 762,P<0. 001)和手术时间> 75 min(OR=1. 764,95%CI:1. 365~2. 667,P=0. 001)是导致半髋关节置换术后发生关节假体周围感染的独立危险因素。结论术前CRP水平升高、BMI较高和手术时间延长是生物型半髋关节置换术后早期发生关节假体周围感染的独立预测因素。Objective To investigate the risk factors for early periprosthetic joint infections in the elderly patients with femoral neck fracture after hemiarthroplasty. Methods This study retrospectively enrolled the patients with femoral neck fractures( AO/OTA 31-B) who underwent hemiarthroplasty in our hospital from January 2012 to December 2017. The patients were assessed for signs of periprosthetic joint infections within 4 weeks postoperation. The independent risk factors and diagnostic thresholds affecting infection around the joint prosthesis were analyzed. Results A total of 390 patients were enrolled in the study,and 18 cases occurred periprosthetic joint infections postoperation,with an incidence rate of 4. 6%. Univariate analysis showed that higher body mess index( BMI),elevated preoperative C-reactive protein( CRP),prolonged operation time,diabetes mellitus,and glucocorticoid use were associated with periprosthetic joint infections( P< 0. 05). The diagnostic thresholds of BMI,preoperative CRP,and operation time for infection around the joint prosthesis were confirmed by ROC curves to be 25. 3,14. 2 mg/L,and 75. 0 min,respectively. Multivariate Logistic regression analysis indicated that BMI > 25. 3( OR = 2. 232,95% CI: 1. 514-3. 465,P<0. 001),CRP >14. 2 mg/L( OR = 1. 438,95% CI: 1. 201-1. 762,P<0. 001) and operation time > 75 min( OR = 1. 764,95% CI: 1. 365-2. 667,P = 0. 001) were independent risk factors for periprosthetic joint infections after hemiarthroplasty. Conclusions The elevated preoperative CRP,higher BMI,and prolonged operation time are independent predictors of periprosthetic joint infections after biological hemiarthroplasty.

关 键 词：股骨颈骨折 半髋关节置换术 假体周围感染 C反应蛋白 体质量指数 

分 类 号：R687.4[医药卫生—骨科学]