人工关节置换术后假体周围感染与术前贫血的研究进展

Periprosthetic joint infection after artificial joint replacement and preoperative anemia

假体周围感染是人工关节置换术后最严重的并发症。流行病学调查发现,围术期贫血是造成假体周围感染的独立危险因素,其可通过影响细胞机制及自身免疫功能等多个方面发挥重要影响。既往国内外诸多学者对假体周围感染与术后贫血的关系进行研究,但对假体周围感染与术前贫血的相关性探讨较少。术前贫血可使红细胞表面的C3b受体减少,机体免疫功能降低,血源性感染增加,术后康复时间延长,进而诱发假体周围感染。故对于术前合并贫血的患者,除预防性使用抗生素外,术前应补充铁剂、配合促红细胞生成素积极纠正贫血、治疗影响血红蛋白生成的慢性并发症、提高患者自身的免疫状况、对符合输血指征的患者进行相应的输血治疗,从而更好地预防人工关节置换术后假体周围感染的发生,减少二次或多次翻修的概率。

Periprosthetic joint infection is the most serious complication after artificial joint arthroplasty. Epidemiological investigation has indicated that perioperative anemia is an independent risk factor for periprosthetic joint infection,which could play an important role by suppressing cellular mechanisms and autoimmune functions. Many domestic and overseas scholars have studied the relationship between periprosthetic joint infection and postoperative anemia,but the relationship between preoperative anemia and periprosthetic joint infection is relatively rare. However,preoperative anemia can reduce the C3b receptor on surface of red blood cells,decrease immune function of the body,increase blood borne infection,prolong postoperative rehabilitation time,and lead to periprosthetic joint infection. For patients with preoperative anemia,prophylactic antibiotics could be used to prevent. And complement chalybeate used before operation,correct anemia by hemopoietin,treat chronic complications influence by hemoglobin production and improve patient＇s own immune status,blood transfusion treatment for patients with blood transfusion indications are performed. It could be better prevent occurrence of periprosthetic joint infection after total joint arthroplasty,and reducing chance of secondary or multiple renovations.