Ⅱ期翻修治疗凝固酶阴性葡萄球菌假体周围感染的临床观察

Clinical observation on the treatment of periprosthetic infection of coagulase-negative staphylococci by two-stage revision

目的 :探讨Ⅱ期翻修治疗凝固酶阴性葡萄球菌假体周围感染失败的危险因素。方法 :回顾2005年1月至2015年6月就诊的57例因凝固酶阴性葡萄球菌造成的髋、膝关节假体周围感染而行Ⅱ期翻修患者,平均年龄(61.3±11.9)岁。根据甲氧西林是否耐药分为甲氧西林敏感(MSCo N)组及甲氧西林耐药(MRCo N)组,其中MSCo N组患者25例(9膝16髋,男12例,女13例),MRCo N组患者32例(11膝21髋,男14例,女18例);随访至少2年,比较两组炎症指标、窦道发生率和症状持续时间,以及Ⅱ期翻修治疗后再感染或持续感染率。结果:MSCo N组和MRCo N组分别经过(81.7±38.3)个月及(65.9±33.8)个月的随访,各治疗成功23例和27例,两组差异无统计学意义(P=0.643)。既往有手术史患者比无手术史患者失败的可能性高4.04倍[OR=4.04,95%CI(0.62,26.5)]。既往有窦道的患者比无窦道的患者失败的可能性高4.26倍[OR=4.26,95%CI(0.7,25.9)]。结论:在治疗甲氧西林耐药与敏感的凝固酶阴性葡萄球菌引起的假体周围感染方面,Ⅱ期翻修能取得良好的效果。甲氧西林耐药的凝固酶阴性葡萄球菌引起的假体周围感染并非Ⅱ期翻修治疗失败的危险因素,窦道及既往手术史可能是Ⅱ期翻修治疗失败的原因。

Objective：To investigate the risk factors for the failure in treating periprosthetic infection of coagulase-negative staphylococci by two-stage revision. Methods：From January 2005 to June 2015,57 patients with periprosthetic hip and knee joint infection of coagulase-negative staphylococcus by two-stage revision were retrospectively reviewed with an average age of（61.3±11.9） years old. According to the drug resistance of methicillin,the patients were divided into methicillin sensitive group（MSCo N） and methicillin resistance（MRCo N） group,25 cases in MSCo N group（9 knees and 16 hips） included12 males and 13 females,32 cases in MRCo N group（11 knees and 21 hips） included 14 males and 18 females. Follow-up for at least 2 years,the inflammatory markers,incidence rate of sinus and the duration of the symptoms,reinfection or persistent infection rate after two-stage revision were compared between two groups. Results：MSCo N group and MRCo N group were followed up（81.7±38.3） months and（65.9±33.8） months,respectively;23 cases and 27 cases were successfully treated;there was no significant difference between two groups（P=0.643）. The patients who had surgery history were 4.04 times higher of failure than the patients without a history of surgery [OR=4.04,95%CI（0.62,26.5）]. Patients who had sinus were 4.26 times higher of failure than the patients without sinus [OR=4.26,95%CI（0.7,25.9）]. Conclusion：Two-stage revision is an effective procedure in treating patients infected by MSCo N and MRCo N. There is no significant difference of treatment failure rate between MSCo N and MRCo N group by two-stage revision. Surgery history and sinus maybe the risk factors of treatment failure,while methicillin-resistance is not.