假体周围感染抗生素骨水泥间置后再感染的因素

Factors related to re- infection after antibiotic bone cement spacer of periprosthetic joint infection

摘要:

[目的]探讨抗生素骨水泥间置治疗假体周围感染（periprosthetic joint infection, PJI）失败的危险因素。[方法]回顾性分析本院 2017 年 1 月—2020 年 7 月收治的 69 例 PJI 患者的临床资料。根据患者抗生素骨水泥间置术后是否出现再次感染， 将其分为再感染组和治愈组。采用单因素比较和 Cox 分析探讨抗生素骨水泥间置术后再次感染的影响因素。[结果]所有患者均获随访，随访时间 0.5~52.9 个月，69 例患者中，15 例抗生素骨水泥间置术后出现了再次感染的情况，感染发生时间为术后 0.5~9.1 个月，中位感染发生时间为术后 2.2 个月。单因素比较表明，两组患者在年龄、性别构成、吸烟史、饮酒史、ASA 等级、 aCCI 评分、糖尿病、高血压、冠心病、类风湿性关节炎、既往感染史及微生物学培养结果的差异均无统计学意义（P＞0.05）；但是，再感染组的既往髋膝关节翻修史比率 [是/否, (5/10) vs (4/50), P＜0.05] 和窦道比率 [是/否, (7/8) vs (9/45), P＜0.05] 显著高于治愈组。Cox 分析表明，既往髋膝关节翻修 （HR=3.755, 95% CI 1.264~11.152, P=0.017） 及存在窦道 （HR=2.834, 95% CI 1.018~ 7.885, P=0.046）是 PJI 患者经抗生素骨水泥间置术后再发感染的独立危险因素。[结论] 既往髋膝关节翻修史及存在窦道是 PJI 患者经抗生素骨水泥间置术后再发感染的独立危险因素，应引起临床医生重视。

Abstract:

[Objective] To search the factors related to failure of antibiotic bone cement spacer in the treatment of periprosthetic joint in- fection (PJI). [Methods] A retrospective study was conducted on 69 patients who received debridement and antibiotic bone cement spacer in the primary stage for PJI in our hospital from January 2017 to July 2020. The patients were divided into the re-infection group and cured group according to whether they had re-infection after the antibiotic bone cement spacer was removed. Univariate comparison and Cox analy- sis were used to investigate the influencing factors of reinfection after antibiotic bone cement spacer removed. [Results] All patients were fol- lowed up for 0.5 to 52.9 months after the debridement and antibiotic bone cement spacer placement. Among the 69 patients, 15 patients had reinfection, which occurred at 0.5 to 9.1 months after the surgery with a median time of 2.2 months after the surgery. As results of univariate comparison, there were no statistically significant differences in terms of age, gender composition, smoking history, drinking history, ASA grade, aCCI score, diabetes, hypertension, coronary heart disease, rheumatoid arthritis, past infection history and microbial culture results between the two groups (P＞0.05); However, the re-infection group had significantly higher ratio of previous same-joint revision history [yes/ no, (5/10) vs (4/50), P＜0.05] and the sinus ratio [yes/no, (7/8) vs (9/45), P＜0.05] than the cured group. Based on the consequence of Cox analy- sis, the previous revision history (HR=3.755, 95% CI 1.264~11.152, P=0.017) and the presence of sinus tract (HR=2.834, 95% CI 1.018~ 7.885, P=0.046) were independent risk factors for recurrent infection in PJI after removal of the antibiotic bone cement spacer. [Conclu- sion] Previous revision history and the presence of sinus tract are independent risk factors for re-infection in PJI patients after removal of the antibiotic bone cement spacer which should be paid attention to by clinicians.