髋膝关节置换术后假体周围感染的危险因素分析

Risk factors for periprosthetic infections after hip and knee arthroplasty

目的探讨髋膝关节置换术后假体周围感染的危险因素,为临床降低感染率提供依据。方法选择医院2000年1月-2012年1月髋膝关节置换手术后出现假体周围感染的27例患者作为病例组,髋关节置换15例、膝关节置换12例,按1∶2的比例配比术后未出现感染的54例患者为对照组,比较两组间相关危险因素的差异,采用SPSS 13.0软件进行统计处理,两组计数资料比较采用两独立样本的t检验或Wilcoxon秩和检验,将有意义的单因素代入多变量logistic回归分析模型进行多因素分析。结果髋关节假体周围感染以表皮葡萄球菌感染最多占40.0%,而膝关节假体感染以金黄色葡萄菌为主占54.5%;膝关节置换患者在脓性渗液和引流管两组比较差异有统计学意义,髋关节置换患者两组间在体质量指数、引流量和表浅感染差异有统计学意义。结论脓性渗液的出现对膝关节假体感染具有重要的临床意义,使用引流管可以降低膝关节置换假体感染的风险,肥胖及术后引流量较多的患者髋关节假体感染的风险较高。

OBJECTIVE To explore the risk factors for periprosthetic infections after the hip and knee arthroplasty so as to reduce the incidence of infections. METHODS Totally 27 patients who underwent the hip and knee arthroplasty in the hospital from Jan 2000 to Jan 2012 and were complicated with postoperative periprosthetic infections, including 15 cases of hip arthroplasty and 12 cases of knee arthroplasty, were chosen as the case group; in a 1：2 ratio, 54 patients without postoperative periprosthetic infections were set as the control group, then the related risk factors were compared between the two groups, the statistical analysis was performed with the use of SPSS13.0 software, the count data of the two groups were compared by using t-test or Wilcoxon rank sum test, and the single factor with significance was included to the multivariate logistic regression analysis model for multivariate analysis. RESULTS The hip prosthesis patients with the periprosthetic infections caused by the Staphylococcus epidermidis accounted for 40.0%, with the proportion highest, and the knee prosthesis patients with the periprosthetic infections caused by the Staphylococcus aureus accounted for 54.5 %. The difference in the purulent exudates or the drainage tube of the knee arthroplasty patients was statistically significant; the difference in the body mass index, drainage volume, or incidence of superficial infections in the hip arthroplasty patients was statistically significant. CONCLUSION The occurrence of purulent exudates has great clinical significance to the knee periprosthetic infections; the use of drainage tube may reduce the risk of keen periprosthetic infections; the hip arthroplasty patients with obesity and much drainage volume are at the high risk of periprosthetic infections.