如何降低全髋置换术术后感染？

来源：304关节学术  

译者：张蔷 解放军总医院第四医学中心

文献出处：Adili A, Bhandari M, Bozzo A, et al. Risk Factors for Periprosthetic Joint Infection Following Primary Total Hip Arthroplasty: A 15-Year, Population-Based Cohort Study. J Bone Joint Surg Am. 2020 Mar 18;102(6):503-509. doi: 10.2106/JBJS.19.00537.

初次全髋关节置换术后假体周围感染的危险因素：

一项15年随访大样本量队列研究

Risk Factors for Periprosthetic Joint Infection Following Primary Total Hip Arthroplasty: A 15-Year, Population-Based Cohort Study

译者：张蔷

Background: Periprosthetic joint infection (PJI) is one of the most devastating complications following total hip arthroplasty. The purposes of this study were to determine risk factors for PJI after primary total hip arthroplasty for osteoarthritis using a Canadian population-based database collected over 15years and to determine the incidence of PJI, the time to PJI following primary total hip arthroplasty, and whether the PJI rate had changed over 15 years.

背景：假体周围感染是一项全髋关节置换术后最有破坏力的并发症之一。本研究基于加拿大国家数据库15年的随访数据，用于确定因骨关节炎而接受初次全髋关节置换术后假体周围感染的危险因素，重点指标包括假体周围感染（PJI）的发生率，初次置换到感染的时间以及15年来假体周围感染率是否出现变化。

Methods: We performed a population-based cohort study using linked administrative databases in Ontario. We included all primary total hip arthroplasties performed for osteoarthritis in patients who were ≥55 years of age. We used a Cox proportional hazards model to analyze the effect of surgical and patient factors on the risk of developing PJI. We calculated 1, 2, 5, and 10-year PJI rates. We used the Cochran-Armitage test to assess the evidence of trends in PJI rates over time.

方法：我们使用了安大略省的相关数据进行了一项大样本量的队列研究。入选标准为年龄≥55岁因骨关节炎（OA）接受初次全髋关节置换手术的所有病例。我们使用Cox比例风险模型分析了患者出现PJI的手术相关因素以及自身相关因素风险。我们记录了1年、2年、5年和10年的PJI发生率，同时使用Cochran-Armitage检验法评价了PJI发生率随时间的变化趋势。。

Results: A total of 100,674 patients who were ≥55 years of age underwent a primary total hip arthroplasty for osteoarthritis. The cumulative incidence for PJI at 15 years was 1.44% (95% confidence interval [CI], 1.38% to 1.50%). Risk factors associated with the development of PJI include male sex (hazard ratio [HR], 1.43 [95% CI, 1.30 to 1.51]), type-2 diabetes mellitus (HR, 1.51 [95% CI, 1.31 to 1.70]), and being discharged to convalescent care (HR, 1.36 [95% CI, 1.05 to 1.77]). Sixty-two percent of PJI cases occurred within 2 years after the surgical procedure and 98% occurred within 10 years. The rate of PJI following primary total hip arthroplasty did not change over the 15 years of our study period.

结果：共有100674例55岁及以上年龄接受初次全髋关节置换手术的患者入组。15年PJI的累积发病率为1.44%(95%置信区间[CI], 1.38%~1.50%)。与PJI形成相关的危险因素包括男性（风险比（HR），1.43[95%CI, 1.30~1.51]），2型糖尿病（HR, 1.51[95%CI, 1.31~1.70]）和出院后转入康复治疗机构（HR, 1.36[95%CI, 1.05~1.77]）。62%的PJI病例出现在初次置换术后2年内，而98%的病例都出现在术后10年内。15年间初次全髋关节置换术后PJI的发生率并没有显著变化。

Conclusions: The risk of developing PJI following primary total hip arthroplasty did not change in 15 years, despite improvements in other arthroplasty outcomes. Male sex, type-2 diabetes mellitus, and discharge to convalescent care were associated with an increased risk of PJI. The surgical approach, income quintile, and use of bone-grafting or cement were not significantly associated with increased risk of infection in our cohort.

结论：尽管在其他领域有一定的进步，初次全髋关节置换术后发生PJI的风险在过去15年间并没有显著的变化。男性、2型糖尿病和出院转入康复治疗机构是与PJI相关的危险因素。而手术入路、收入、植骨和骨水泥的应用在我们的研究中并没有显现出与感染风险相关。

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2020中国综合医院手术量排行榜前100强医院的手术总量为906.24万台，占2019年中国医院（34354家医院）总手术量的15.4%。

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