分期翻修术治疗关节置换术后感染的预测因素分析

Predictors of failure in two-stage exchange arthroplasty for infected joint replacement

[目的]评价分期方案治疗关节置换术后假体周围感染的失败率及影响预后的预测因素。[方法]自2000年1月～2010年10月收治关节置换术后假体周围感染患者31例(女19例,男12例),发生感染时平均年龄62.9岁(26～86岁),其中髋关节置换术后感染13例,膝关节置换术后感染18例。手术方法:一期取除原有假体并置入包含抗生素的骨水泥间隔,待感染得到有效控制后再二期置入新的假体,分析其失败率,并将治愈组与失败组中所有可能的影响因素相比较。[结果]所有患者随访2年。其中`7例治疗失败,通过单因素分析发现没有任何指标对再次假体置入的时机具有指导意义。通过logistic回归分析发现穿刺液细菌培养阳性患者的失败率较高(OR=1.5,P=0.79,95%C.I.0.07～31.6);而关节液白细胞计数(OR=1.003,P=0.65,95%CI 0.99～1.02)及中性粒细胞比例增高(OR=1.08,P=0.22,95%CI 0.96～1.21)同样有较高的失败率。[结论]分期方案治疗关节置换术后假体周围感染仍具有较高的失败率,目前尚缺乏科学的指标来确定二期置入假体的时机。

[ Objective ] To identify the rate of recurrent periprosthetic joint infection after two - stage exchange and the role of different factors influencing the outcome of two - stage revision. [ Method ] Thirty-one patients who had undergone two - stage exchange arthroplasty for PJI were respectively studied between 2000 and 2010. Failure of two - stage revision and surgical fac-tors that might be related to failure were defined. [ Result] Minimum follow-up was 2 years. ESR and CRP values at the time of reimplantation and time from resection to reimplantation were not predictors. Joint fluid WBC （ OR = 1. 003, P = 0.65,95 % C. I. O. 99 - 1.02 ） ,joint fluid PMN% （ OR = 1.08 ,P = 0.22,95% C. I. 0.96 - 1.21 ） and positive joint fluid culture（ OR = 1.5 ,P = 0.79,95 % C. I. 0.07 - 31.6 ） were provided as predictors of failure. [ Conclusion ] Failure rate after two - stage reimplantation for infected arthroplasty is relatively high. No variables would guide the surgeon in identifying acceptable circumstances to per-form the second stage.