非感染性髋关节翻修术中单个标本病原微生物培养阳性的相关因素分析  

Analysis of related factors for unexpected positive intraoperative cultures in aseptic hip revision surgery

作　　者：侯耀宗 李亦丞 努尔艾力江·玉山 吾湖孜·吾拉木[1] 郭晓斌 曹力[1] 张晓岗[1] Hou Yaozong;Li Yicheng;Yushan Nuerailijiang;Wulamu Wuhuzi;Guo Xiaobin;Cao Li;Zhang Xiaogang(Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University,Key Laboratory of High Incidence Disease Research in Xingjiang(Xinjiang Medical University),Ministry of Education,Xinjiang Clinical Research Center for Orthopedics,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院关节外科、新疆地区高发疾病研究教育部重点实验室(新疆医科大学)新疆骨科疾病临床医学研究中心,乌鲁木齐830054

出　　处：《中华外科杂志》2025年第3期248-254,共7页Chinese Journal of Surgery

基　　金：国家自然科学基金地区科学基金项目(82160421);新疆维吾尔自治区科技计划重大专项项目(2022A03011);新疆维吾尔自治区自然科学基金(2023D01E11);新疆维吾尔自治区科学技术厅科技创新团队项目(2023TSYCTD0014);“天山英才”医药卫生高层次人才培养计划(TSYC202301A008)。

摘　　要：目的探讨因非感染性因素接受髋关节翻修术的患者术中单个标本病原微生物培养阳性的相关因素。方法本研究为回顾性病例系列研究。回顾性分析新疆医科大学第一附属医院关节外科2012年1月至2021年12月因非感染性因素接受髋关节翻修术的397例患者的临床资料。其中男性225例,女性172例,年龄[M(IQR)]58(23)岁(范围:21~89岁),体重指数25(6)kg/m^(2)(范围:15~39 kg/m^(2))。根据是否存在术中单个标本病原微生物培养阳性将患者分为培养阳性组(32例)和培养阴性组(365例)。统计两组患者的一般资料,包括性别、年龄、体重指数、术前C反应蛋白、术前红细胞沉降率、美国麻醉医师协会(ASA)分级,是否出现术前尿细菌阳性,是否合并低蛋白血症、贫血、糖尿病、慢性阻塞性肺疾病、脑梗死,是否有抗菌药物过敏史、吸烟史、饮酒史,既往假体脱位病史、手术干预史等;手术资料包括出现症状至入院时间、手术时间等。采用Mann-Whitney U检验、χ^(2)检验进行单因素分析,将P<0.20的变量纳入多因素Logistic回归分析,确定因非感染性因素接受髋关节翻修术的患者术中标本病原微生物培养阳性的相关因素。临床结局定义为:(1)无论因何种原因再次接受外科手术治疗;(2)出现窦道、切口渗液等感染症状;(3)持续存在髋关节过度疼痛。以任意原因导致的临床结局作为终点事件,绘制Kaplan-Meier生存曲线,采用Log-rank检验比较培养阴性组与培养阳性组的10年假体生存率。结果单因素分析结果中P<0.20的变量包括性别、体重指数、ASA分级、术前尿细菌阳性(χ^(2)=2.368,P=0.124;χ^(2)=-1.648,P=0.098;χ^(2)=14.128,P=0.003;χ^(2)=7.384,P=0.007)。多因素Logistic回归分析结果显示,男性、ASA分级Ⅳ级、术前尿细菌阳性是因非感染性因素接受髋关节翻修患者术中单个标本病原微生物培养阳性的独立危险因素(OR=2.35,95%CI:1.08~5.36,P=0.040Objective To investigate the related factors for unexpected positive intraoperative cultures(UPC)in patients undergoing aseptic hip revision and the long-term prosthesis survival rate in such patients.MethodsA retrospective cases series analysis was conducted in 397 patients who underwent aseptic hip revision surgery at the Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University from January 2012 to December 2021.There were 225 females and 172 males with an age(M(IQR))of 58(23)years(range:21 to 89 years)and a body mass index(BMI)of 25(6)kg/m^(2)(range:15 to 39 kg/m^(2)).Based on the culture results of intraoperative specimens,patients were divided into culture-positive group(32 cases)and culture-negative group(365 cases).The clinical data were analyzed including gender,age,BMI,preoperative C-reactive protein,preoperative erythrocyte sedimentation rate,American Society of Anesthesiologists(ASA)classification,preoperative urinary bacteria,preoperative hypoproteinemia;comorbidities of diabetes mellitus,anemia,chronic obstructive pulmonary disease,cerebral infarction;history of allergy to antibiotics,smoking,drinking,previous prosthetic dislocation,previous surgical intervention;and time from symptom onset to admission,duration of surgery,etc.A univariate analysis was performed by Mann-Whitney U orχ^(2)test and the independent risk factors were identified by including the independent variables with P<0.20 in the univariate analysis in a logistic regression analysis of dichotomous variables.The study outcomes were defined as:(1)re-surgical treatment for any reason;(2)symptoms of infection such as sinus and incision seepage;(3)persistent excessive hip pain.The Kaplan-Meier survival curve was plotted using the study outcome of any cause as the endpoint event,and the log-rank test was used to compare the 10-year survival rate of the prosthesis in the culture-negative group with that in the culture-positive group.ResultsUnivariate analysis showed statistically significant differences between t

关 键 词：关节成形术 置换 髋 带病原状态 非感染性失败 人工关节翻修术 髋关节 病原菌 早期医疗干预 

分 类 号：R687.4[医药卫生—骨科学] R446.5[医药卫生—外科学]