初次全膝关节置换术后手术部位感染危险因素研究  

Risk factors analysis of surgical site infection in primary total knee arthroplasty

作　　者：田学武 金群华[2] 张强[2] Tian Xuewu;Jin Qunhua;Zhang Qiang(Department of Orthopedics, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China;The Third Department of Orthopedics,General Hospital of Ningxia Medical University,Ningxia 750004, China)

机构地区：[1]首都医科大学附属北京地坛医院骨科,北京100015 [2]宁夏医科大学总医院骨三科,750004

出　　处：《中华关节外科杂志（电子版）》2021年第3期283-288,共6页Chinese Journal of Joint Surgery(Electronic Edition)

摘　　要：目的分析人工全膝关节置换术(TKA)后手术部位感染(SSI)的危险因素。方法回顾性分析所有在2011年1月1日到2018年12月31日因膝骨关节炎在宁夏医科大学总医院骨三科接受初次TKA的1462例患者一般资料。依据手术部位感染定义,纳入初次TKA手术患者,排除翻修术者,分为SSI组28例与非SSI组1434例,收集患者年龄、性别、身体质量指数(BMI)、尿检结果、异体输血、住院天数及是否患有糖尿病、类风湿疾病、肺部感染性疾病、心血管疾病、下肢血管疾病、肝病(病毒性肝炎、肝硬化等)等相关资料,采用logistic回归计算比值比(OR)和95%置信区间(CI)分析SSI风险因素。结果TKA术后患者SSI总发生率为1.9%。经初步筛选,logistic回归分析显示异体输血[OR=6.567,95%CI(2.558,16.858)]、术前长期类固醇使用史[OR=20.071,95%CI(2.678,150.404)]、术前住院时间≥14 d[OR=5.699,95%CI(1.615,20.111)]、术前无症状细菌尿[OR=3.572,95%CI(1.128,11.312)]、合并肺部感染性疾病[OR=11.705,95%CI(3.794,36.105)]及肝病(病毒性肝炎、肝硬化等)[OR=5.848,95%CI(2.034,16.814)]为手术部位感染的独立危险因素(P<0.05)。结论人工全膝关节置换术后手术部位感染的危险因素较复杂,应针对感染危险因素实施有效的预防措施。Objective To analyze the risk factors of surgical site infection(SSI)in patients undergoing primary total knee arthroplasty(TKA).Methods A retrospective analysis was performed on the general date of all 1462 patients who underwent primary total knee arthroplasty due to knee osteoarthritis in the third department of orthopedics,General Hospital of Ningxia Medical University from January 1,2011 to December 31,2018.According to the definition,the patients undergoing primary TKA were included,those undergoing revision surgery were ecluded.Twenty-eight cases in the SSI group and 1434 cases in the non-SSI group were screened respectively.Age,gender,body mass index(BMI),urine test results,the length of hospital stay and allogeneic blood transfusion of the two groups were collected and included in the study.Comorbidity such as diabetes,rheumatoid disease,pulmonary infectious disease,cardiovascular disease,lower extremity vascular disease,liver disease(viral hepatitis,cirrhosis,etc.)were calculated.Logistic regression analysis for the odds ratio(OR)and 95%confidence interval(CI)was used to determine the influencing factors.Results The overall infection rate of the surgical site after total knee arthroplasty in this study was 1.9%.Logistic regression analysis showed that allogeneic blood transfusion[OR=6.567,95%CI(2.558,16.858)],long-term hormone use history before surgery[OR=20.071,95%CI(2.678,150.404)],hospitalization time≥14 days before surgery[OR=5.699,95%CI(1.615,20.111)],asymptomatic bacterial urine[OR=3.572,95%CI(1.128,11.312)],combined with pulmonary infectious diseases[OR=11.705,95%CI(3.794,36.105)](COPD,etc.)and liver disease[OR=5.848,95%CI(2.034,16.814)](viral hepatitis,cirrhosis,etc.)were influential factors for SSI(P<0.05).ConclusionThe risk factors for surgical site infection after primary total knee arthroplasty are complicated,and effective measures should be taken to prevent SSI after surgery.

关 键 词：骨关节炎 关节成形术 置换 膝 外科伤口感染 危险因素 

分 类 号：R68[医药卫生—骨科学]