一期翻修关节腔局部用药治疗髋关节假体周围感染后急性肾损伤的危险因素分析  

Analysis and research on acute kidney injury following one-stage revision combined with intra-articular antibiotics infusion for hip periprosthetic joint infection

作　　者：胡强德 曹力[1] 胥伯勇[1] 郭文涛[1] 吐尔洪江·瓦哈甫 邹晨 花龙 穆文博 Hu Qiangde;Cao Li;Xu Boyong;Guo Wentao;Tuerhongjiang·Wahafu;Zou Chen;Hua Long;Mu Wenbo(Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China)

机构地区：[1]新疆医科大学第一附属医院关节外科,乌鲁木齐830054

出　　处：《中华骨科杂志》2025年第5期271-279,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金委员会,地区科学基金项目(82260435);新疆维吾尔自治区科学技术厅,重大科技专项项目(2022285490);“天山英才”青年拔尖人才项目一青年人才托举工程(2023TSYCQNTJ0003);新疆地区高发疾病研究教育部重点实验室开放课题重点项目(2023A01)。

摘　　要：目的探讨一期翻修手术联合关节腔局部使用抗生素治疗髋关节假体周围感染(periprosthetic joint infection,PJI)后发生急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析2010年5月至2024年4月于新疆医科大学第一附属医院关节外科因髋关节PJI接受一期翻修手术联合关节腔局部用药治疗的168例患者资料,男87例、女81例,年龄为(60.1±14.6)岁(范围21~89岁),体质指数(body mass index,BMI)为(24.9±4.6)kg/m^(2)(范围17~41 kg/m^(2))。PJI的诊断符合2011年肌肉与骨骼感染协会(Musculoskeletal Infection Society,MSIS)标准。对AKI组和非AKI组年龄、性别、BMI、BMI≥30 kg/m^(2)(是/否)、美国麻醉医师协会(American Society of Anesthesiologists,ASA)评分(Ⅱ/Ⅲ级)、高血压、糖尿病、慢性肾脏疾病、手术侧别(左/右)、静脉使用抗生素持续时间、关节内使用抗生素持续时间、术前输血(是/否)、术后输血(是/否)、基线血红蛋白值、贫血分级(无/轻度/中度)、基线血清肌酐值、基线血清肌酐分级进行单因素分析;将P值<0.10的变量纳入多因素logistic回归模型以明确独立危险因素。结果AKI的总发生率为9.5%(16/168)。Ⅰ期AKI 8例,短暂出现且无需特殊治疗;Ⅱ期AKI 2例,未接受透析治疗;Ⅲ期AKI 6例,其中1例接受临时血液透析,无长期透析患者。AKI组与非AKI组患者年龄、糖尿病、慢性肾脏疾病、ASA评分组的差异有统计学意义(P<0.05)。单因素logistic回归分析显示年龄(P=0.005)、BMI(P=0.078)、ASA评分Ⅲ级(P=0.037)、糖尿病(P=0.025)、慢性肾脏疾病(P=0.003)及低基线血清肌酐水平(P=0.056)是一期翻修术联合关节腔局部使用抗生素治疗全髋关节置换术后PJI发生AKI的危险因素;多因素logistic回归分析显示年龄、慢性肾脏疾病和低基线血清肌酐水平是AKI发生的独立危险因素(P<0.05)。结论一期翻修术联合关节腔局部使用抗生素在治疗全髋关节置换术后PJI时AObjectiveTo study the risk factors for acute kidney injury(AKI)following one-stage revision surgery combined with intra-articular antibiotics infusion for periprosthetic joint infection(PJI)of the hip joint.MethodsA retrospective analysis was conducted on the data of 168 patients with hip PJI who underwent one-stage revision surgery combined with intra-articular antibiotics infusion in the Department of Joint Surgery,the First Affiliated Hospital of Xinjiang Medical University,from May 1,2010 to April 30,2024.There were 87 males and 81 females with an average age of 60.1±14.6 years(range:21-89 years).The body mass index(BMI)was 24.9±4.6 kg/m^(2)(range:17-41 kg/m^(2)).PJI was diagnosed according to the criteria of Musculoskeletal Infection Society(MSIS)in 2011.AKI was diagnosed and classified according to the Kidney Disease:Improving Global Outcomes(KDIGO)criteria.For AKI group and non-AKI group,risk factors were screened by univariate analysis on their age,gender,BMI,BMI≥30 kg/m^(2)(yes/no),American Society of Anesthesiologists(ASA)score(II/III),hypertension,diabetes,chronic kidney disease(CKD),surgical side(left/right),duration of intravenous antibiotic use,duration of intra-articular antibiotic use,preoperative blood transfusion,postoperative blood transfusion,baseline hemoglobin value,anemia grade(none/mild/moderate),baseline serum creatinine value,baseline serum creatinine grade(normal/below normal range/above normal range).Variables with P<0.10 were included in the multivariate logistic regression model to identify independent risk factors.ResultsThe overall incidence of AKI was 9.52%(16/168),among which 50%(8 cases)were stage I AKI,transient and requiring no special treatment.12.5%(2 cases)were stage II AKI and did not undergo dialysis.37.5%(6 cases)were stage III AKI.One case needed temporary hemodialysis,and there was no patient requiring long-term dialysis.There were significant differences in age,diabetes,chronic kidney disease and ASA score between AKI group and non-AKI group(P<0.05).The univariate

关 键 词：关节成形术 置换 髋 急性肾损伤 假体相关感染 注射 关节内 

分 类 号：R687.4[医药卫生—骨科学]