初次全膝置换假体周围感染的相关因素分析△

Related factors of periprosthetic joint infection in primary total knee arthroplasty

摘要:

［目的］ 探讨初次全膝关节置换 （total knee arthroplasty, TKA） 术后假体周围感染 （periprosthetic joint infection, PJI） 的危险因素。［方法］回顾性分析 2010 年 1 月—2020 年 1 月本科初次 TKA 术 525 例患者的临床资料。根据术后是否确诊为 PJI 分为两组，行单因素比较和二元多因素逻辑回归分析，探讨 PJI 发生的危险因素。［结果］525 例全膝关节置换患者中，14 例确诊为 PJI，占 2.67%。细菌培养结果，表皮葡萄球菌 3 例，金黄色葡萄球菌 3 例，溶血性链球菌 2 例，大肠埃希菌 3 例，铜绿假单胞菌 2 例，阴沟肠杆菌 1 例。单因素比较表明，PJI 组患者年龄、男性比例、体质指数、术前合并糖尿病或菌尿、手术时间、术中出血量、术后引流量及术后输注异体血比例高于非 PJI 组（P<0.05）；而 PJI 组患者术前白蛋白及血红蛋白水平显著低于非 PJI 组（P<0.05）。逻辑回归分析显示，患者年龄（OR=1.024，P=0.005）、术前合并糖尿病（OR=3.243，P=0.002）及术后输注异体血 （OR=2.003，P=0.008）是术后假体周围感染的危险因素；而女性（OR=0.786，P=0.007）和高白蛋白水平（OR=0.941，P=0.026） 是减少术后假体周围感染的保护因素。［结论］男性、高龄、术前合并糖尿病、术前白蛋白水平下降及术后输注异体血是初次全膝关节置换术后假体周围感染的危险因素。

Abstract:

[Objective] To explore the risk factors of periprosthetic joint infection (PJI) secondary to primary total knee arthroplasty (TKA) . [Methods] A retrospective study was conducted on 525 patients who underwent primary TKA in our department from January 2010 to January 2020. The patients were divided into two groups according to whether PJI was diagnosed definitively after TKA. Univariate com- parison and binary logistic regression analysis were conducted to search the factors related to PJI. [Results] Among 525 patients, 14 pa- tients were definitively diagnosed of PJI, accounting for 2.67%, with bacteria identified by bacterial culture of staphylococcus epidermidis in 3 cases, staphylococcus aureus in 3 cases, hemolytic streptococcus in 2 cases, escherichia coli in 3 cases, pseudomonas aeruginosa in 2 cases and enterobacter cloacis in 1 case. As consequence of univariate comparison, the PJI group was significantly greater than the non-PJI group in terms of male proportion, age, body mass index (BMI) , underling diabetes, preoperative bacteriuria, the operation time, intraopera- tive blood loss, postoperative drainage, and ratio of postoperative allogeneic blood infusion (P<0.05) , whereas the former had significantly lower preoperative albumin and hemoglobin than the latter (P<0.05) . As results of logistic regression analysis, the age (OR=1.024, P= 0.005) , underling diabetes mellitus (OR=3.243, P=0.002) and postoperative allogeneic blood infusion (OR=2.003, P=0.008) were risk fac- tors for postoperative PJI, whereas female (OR=0.786, P=0.007) and preoperative albumin (OR=0.941, P=0.026) were protective factors for PJI. [Conclusion] Male, advanced age, underling diabetes, low preoperative albumin and postoperative allogeneic blood infusion are risk factors for PJI after primary TKA in this study.