精准病原学诊断指导一期人工关节翻修术治疗慢性假体周围感染的临床效果  

Efficacy of one-stage revision surgery for chronic periprosthetic joint infection guided by precise pathogen diagnosis

作　　者：肖郑伟 洪子豪 曾锦源[1,2,3,4] 张泽宇 吴百健 黄子达 张超凡[1,2,3,4] 方心俞 吴朝阳[1,2,3,4] 张文明 XIAO Zhengwei;HONG Zihao;ZENG Jinyuan;ZHANG Zeyu;WU Baijian;HUANG Zida;ZHANG Chaofan;FANG Xinyu;WU Zhaoyang;ZHANG Wenming(Department of Orthopaedics,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Orthopaedics and Hand Surgery,National Regional Medical Center,Binhai Campus of the First Affliated Hospital,Fujian Medical University,Fuzhou 350212,China;Fujian Provincial Institute of Orthopaedics,the First Affiliated Hospital,Fujian Medical University,Fuzhou 350005,China;Fujian Orthopaedics Bone and Joint Disease and Sports Rehabilitation Clinical Medical Research Center,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院骨科,福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心骨科与手外科,福州350212 [3]福建省骨科研究所,福州350005 [4]福建省骨科骨关节疾病与运动康复临床医学研究中心,福州350005

出　　处：《中华骨与关节外科杂志》2024年第11期975-982,共8页Chinese Journal of Bone and Joint Surgery

基　　金：福建省科技创新联合资金(2022Y4003);福建省卫生健康医学创新课题(2023CXA020);福建省卫生健康中青年领军人才研修培养项目(2023ZQNRCYX-FXY)。

摘　　要：目的:探讨精准病原菌诊断指导一期人工关节翻修术治疗慢性假体周围感染(PJI)的临床效果。方法:选取2018年1月至2022年6月福建医科大学附属第一医院收治的76例接受人工关节翻修术的慢性PJI患者作为研究对象,根据手术方式不同分为一期翻修组(38例)与二期翻修组(38例)。所有PJI患者均通过精准病原学诊断流程进行病原学检测,该流程优化了标本采集、微生物培养条件及分子诊断等技术。比较两组患者术前和术中病原菌检出情况、术后静脉注射靶向抗生素时间、术后2年随访时关节功能情况,以及截至2024年7月31日时两组患者再感染率和假体无感染生存曲线。结果:两组患者术前微生物培养检出数、术前分子诊断检出数、术中微生物常规培养和优化培养检出数比较,差异均无统计学意义(P均>0.05);术后静脉注射靶向抗生素时间比较,差异无统计学意义(P>0.05)。术后2年随访时,两组患者关节ROM和关节功能评分均高于术前,差异均有统计学意义(P均<0.05);两组患者关节ROM和关节功能评分比较,差异均无统计学意义(P均>0.05)。两组患者末次随访再感染率比较,差异无统计学意义(P>0.05)。Kaplan-Meier生存曲线显示,两组患者假体无感染生存曲线大致重合,假体无感染生存率比较,差异无统计学意义(P>0.05)。结论:精准病原学诊断流程在慢性PJI治疗中具有重要价值,在获得明确病原学诊断结果的前提下,一期人工关节翻修术结合靶向抗生素的治疗效果与二期人工关节翻修术相当。Objective:To evaluate the clinical efficacy of one-stage revision surgery for chronic periprosthetic joint infection(PJI) guided by precise pathogen diagnosis.Methods:A total of 76 patients with chronic PJI who underwent revision arthroplasty at the First Affiliated Hospital of Fujian Medical University from January 2018 to June 2022 were enrolled in the study.Patients were divided into two groups based on the surgical approach:the one-stage revision group(38 cases) and the two-stage revision group(38 cases).All patients underwent pathogen diagnosis through the PJI precise etiological diagnosis process developed by the research team,which optimized sample collection,culture conditions,and molecular diagnostics.Key outcomes,including preoperative and intraoperative pathogen detection rates,duration of postoperative intravenous targeted antibiotic therapy,joint function at 2 years postoperatively,and reinfection rates and survival curves up to July 31,2024,were compared between the two groups.Results:There were no statistically significant differences in the number of preoperative and intraoperative culture detections,preoperative molecular diagnostics,or optimized intraoperative culture detections between the two groups(all P>0.05).The duration of intravenous targeted antibiotic therapy showed no statistically significant difference postoperatively(P>0.05).Both groups showed significantly improved range of motion(ROM) and joint function scores at the 2-year follow-up(all P<0.05).However,there were no statistically significant differences in ROM or joint function scores between the two groups(all P>0.05).The long-term follow-up showed similar reinfection rates between the two groups(P>0.05).Survival analysis revealed no statistically significant differences in prosthesis infection-free survival(P>0.05).Conclusions:The precise pathogen diagnostic process plays a crucial role in the treatment of chronic PJI.When pathogen information is reliably obtained,one-stage revision surgery combined with targeted antibiotic the

关 键 词：慢性假体周围感染 精准病原学诊断 优化培养流程 一期人工关节翻修术 疗效比较 

分 类 号：R687.4[医药卫生—骨科学]