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JBJS:假体周围感染增加关节置换患者死亡率

2014-02-17 小小老虎 dxy

关节置换手术为现在的常见手术,可明显改善患者肢体功能提高生活质量。虽然关节置换术后的并发症并不常见,但是术后发生假体关节感染对患者的影响非常巨大。虽然通过预防性使用抗生素、检测和去除定植的金葡菌、提高手术室无菌等级等方法可减少假体感染的发生,但假体感染的发生率仍在1%左右。最近的一项研究表明感染不仅是导致髋关节翻修的第三常见原因而且是膝关节置换失败的主要原因。假体关节感染的危险因素包括男性、高龄患

关节置换手术为现在的常见手术,可明显改善患者肢体功能提高生活质量。虽然关节置换术后的并发症并不常见,但是术后发生假体关节感染对患者的影响非常巨大。虽然通过预防性使用抗生素、检测和去除定植的金葡菌、提高手术室无菌等级等方法可减少假体感染的发生,但假体感染的发生率仍在1%左右。最近的一项研究表明感染不仅是导致髋关节翻修的第三常见原因而且是膝关节置换失败的主要原因。【原文下载】

假体关节感染的危险因素包括男性、高龄患者、高体重指数以及合并其他疾病(尤其是心血管疾病),同时这些危险因素也和患者术后早期死亡密切相关,因此假体感染和死亡率也存在一定关系。为了解关节假体感染和患者死亡率之间的关系、预测假体感染导致患者死亡的可能因素,美国宾夕法尼亚州托马斯杰弗森医院的Benjamin Zmistowski医生进行了一项回顾性研究,其结果发表在2013年12月的JBJS杂志上。

在2000年1月至2010年3月期间一共有2955例患者进行髋关节或膝关节的返修手术。通过检测ESR、CRP、关节液及组织细菌培养等方法确诊假体感染患者。排除资料不全的患者,最终将436例因假体关节感染进行翻修的患者与2342例无菌性假体失败翻修的患者进行比较分析。

为了解假体关节感染导致患者一年内死亡的预测因素,对性别、年龄、种族、下肢关节相关手术次数、体重指数、查尔森合并症指数、特殊并发症(如心脏病、糖尿病等)、和感染组织进行双变量和多变量回归分析。

通过统计分析结果显示:各时期内假体关节感染组翻修患者的死亡率均明显高于非感染翻修组患者,术后90天为3.7%比0.8%,术后1年为10.6%比2.0%,术后2年为13.6%比3.9%,术后5年为25.9%比12.9%。将年龄、性别、种族、手术次数、假体感染部位、体重指数及查尔森合并症指数等因素代入进行校正后,发现假体关节感染组患者的死亡率较非感染组患者增加了5倍。在假体周围关节感染人群中,年龄、查尔森合并症指数、中风病史、多种细菌感染和心脏病病史是患者发生死亡的独立预测因素。


图1 从入院进行返修手术到术后5年的患者Kaplan-Meier生存曲线。A代表非感染性关节返修患者 S 假体关节感染性翻修患者。

通过本次研究,作者认为:假体关节感染将会导致患者死亡风险显著增高。假体关节感染不仅是患者身体健康状态下降的一个表现,而且也会直接导致患者死亡,因此,需要重点关注处理假体周围感染以及调整患者机能治疗慢性疾病。

原始出处:
Zmistowski B, Karam JA, Durinka JB, Casper DS, Parvizi J.Periprosthetic joint infection increases the risk of one-year mortality.J Bone Joint Surg Am. 2013 Dec 18;95(24):2177-84. doi: 10.2106/JBJS.L.00789.【原文下载】

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    2014-12-31 yxch48
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    2014-02-19 qingrejiedu
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