清创保留假体联合抗生素治疗急性人工关节假体周围感染的临床研究  

Debridement,antibiotics irrigation and implant retention for acute periprosthetic joint infection after primary total joint arthroplasty

作　　者：丁浩[1] 房鹏 郭亭 周利武 包倪荣 王北岳 赵建宁[1] Ding Hao;Fang Peng;Guo Ting;Zhou Liwu;Bao Nirong;Wang Beiyue;Zhao Jianning(Department of Orthopaedics,General Hospital of Eastern Theater of PLA,Jinling Clinical College of Nanjing Medical University,Nanjing 210002,China)

机构地区：[1]南京医科大学金陵临床医院(东部战区总医院)骨科,南京210002

出　　处：《中华创伤骨科杂志》2022年第1期54-60,共7页Chinese Journal of Orthopaedic Trauma

摘　　要：目的分析清创保留假体联合抗生素(DAIR)治疗急性人工关节假体周围感染(PJI)的临床疗效,并探讨导致DAIR治疗失败的危险因素。方法回顾性分析2010年1月至2021年1月南京医科大学金陵临床医院骨科因急性PJI行DAIR治疗的122例患者资料,男55例,女67例;年龄50~86岁,平均68.0岁。统计患者入院和出院时C-反应蛋白(CRP)、红细胞沉降率(ESR)、体温、白细胞计数和疼痛视觉模拟评分(VAS),以分析DAIR的临床疗效。将患者根据治疗结果分为治愈组(81例)和未治愈组(41例),对患者的性别、年龄、体重指数、感染部位、感染类型(术后早期感染和急性血源性感染)、手术类型(初次和翻修)、合并症、入院时CRP、ESR、白蛋白、血红蛋白、症状持续时间、金黄色葡萄球菌感染(有/无)、术前窦道(有/无)、多重细菌混合感染(有/无)等进行单因素分析,对于P<0.05的因素再采用logistic回归分析以预测DAIR失败的独立危险因素。以DAIR治疗失败作为终点事件,绘制患者的"生存率"曲线。结果122例患者出院时的CRP、ESR、体温、白细胞计数、VAS评分均低于入院时水平,差异有统计学意义(P<0.05),DAIR治愈率为66.39%(81/122)。logistic回归分析提示:症状持续时间>3周(OR=1.230,95%CI:1.092~1.576,P=0.020)、金黄色葡萄球菌感染(OR=4.607,95%CI:2.057~10.318,P<0.001)、术前存在窦道(OR=6.115,95%CI:2.630~14.220,P<0.001)、多重细菌混合感染(OR=2.600,95%CI:1.131~5.977,P=0.020)是DAIR治疗失败的危险因素;Kaplan-Meier生存率曲线同样证实:症状持续时间>3周、金黄色葡萄球菌感染、术前存在窦道、多重细菌混合感染的患者"生存率"显著低于症状持续时间≤3周、非金黄色葡萄球菌感染、术前没有窦道、非多重细菌混合感染的患者(P<0.05)。结论对于急性PJI,可以选择DAIR治疗达到保留假体、控制感染的目的。但对于金黄色葡萄球菌感染、多重细菌混合感染、症状持Objective To analyze the clinical efficacy of debridement,antibiotics irrigation and implant retention(DAIR)in the treatment of acute periprosthetic infection(PJI)and to explore the risk factors leading to the failure of DAIR.Methods From January 2010 to January 2021,122 patients underwent DAIR for acute PJI at Department of Orthopedics,General Hospital of Eastern Theater of PLA.They were 55 males and 67 females,aged from 50 to 86 years(mean,68.0 years).Their C-reactive protein(CRP),erythrocyte sedimentation rate(ESR),body temperature,white blood cell count and visual analogue scale(VAS)were compared at admission and discharge to analyze the clinical efficacy of DAIR.The 122 patients were assigned into a cured group(81 cases)and an uncured group(41 cases).Risk factors were screened by univariate analysis out of their gender,age,body mass index,site of infection,type of infection(early postoperative infection or acute hematogenous infection),type of surgery(primary or revision),comorbidities,CRP,ESR,albumin and hemoglobin at admission,duration of symptoms,Staphylococcus aureus infection,multiple bacterial mixed infection,and preoperative sinus tract.For the factors of P<0.05,multivariate binary logistic regression analysis was used to determine the risk factors for failure of DAIR.Survival curves were plotted for the patients using DAIR failure as the endpoint event.Results The CRP,ESR,VAS score,body temperature and white blood cell count at discharge in the 122 patients were significantly lower than the corresponding values at admission(P<0.05).The success rate of DAIR was 66.39%(81/122).The multivariate binary logistic regression analysis suggested that duration of symptoms over 3 weeks(OR=1.230,95%CI:1.092~1.576,P=0.020),Staphylococcus aureus infection(OR=4.607,95%CI:2.057~10.318,P<0.001),preoperative sinus tract(OR=6.115,95%CI:2.630~14.220,P<0.001)and multiple bacterial mixed infection(OR=2.600,95%CI:1.131~5.977,P=0.020)were risk factors for DAIR failure;Kaplan-Meier survival curve also confirmed that the pati

关 键 词：关节成形术 置换 假体相关感染 清创术 假体植入 

分 类 号：R687.4[医药卫生—骨科学]