初次髋膝关节置换术后增加假体感染的体重指数阈值及体重阈值的研究

Body mass and weight thresholds for prosthetic joint infection after primary total joint arthroplasty

目的探讨多大的体重指数(BMI)及体重阈值预示着关节置换术后深部感染的概率会增加。方法本实验研究了自2001-06—2016-10收治的9 071例接受髋膝关节置换的患者,所有患者在术前30 min接受1.5 g的头孢呋辛静脉滴注,术后3 d均接受每天2次、每次1.5 g的头孢呋辛静脉滴注。研究的暴露因素是体重指数BMI (5类:<24.9,25～29.9,30～34.9,35～39.9,≥40)和体重(5类:<60 kg,60～79 kg,80～99 kg,100～119 kg和≥120 kg)。接受髋膝关节置换的患者根据BMI从低到高分组的数量分别如下:2 958例,3 352例,1 910例,635例和216例。本研究的实验目的是初次关节置换术后感染发病率。结果所有患者获得随访,随访时间平均为8(0.5～18)年。一共观察到114例人工关节感染,其中69例为术后感染,17例为血性感染,28例为不明原因的感染。前3个BMI(<35)组患者的发病率是相似的,差异无统计学意义,但BMI在35～39.9的患者发病率是BMI<35的患者发病率的2倍(HR=2.1,95%CI:1.1～4.3),BMI≥40的患者发病率是BMI<35的患者发病率的4倍(HR=4.2,95%CI:1.8～9.7)。重量≥100 kg被实验初步证明为增加术后早期感染(HR=2.1,95%CI:1.3～3.6)的体重阈值。结论 BMI≥35或重量≥100 kg可以作为围手术期加大患者抗生素剂量的参照标准之一。

Objective To investigate the body mass and weight thresholds indicating more infection rates after primary total joint arthroplasty. Methods Nine thousand and seventy one patients from June 2001 to October 2016 underwent primary total joint arthroplasty. All of the patients accepted 1.5 g cefuroxime about 30 minutes before operation and twice daily after operation for three days. The main exposures were BMI(<24.9, 25-29.9, 30-34.9, 35-39.9, ≥40) and weight(<60 kg, 60-79 kg, 80-99 kg, 100-119 kg and ≥120 kg). Numbers of patients from low to high BMI were 2958, 3352, 1910, 635, 216 respectively. Results All patients were followed up for an average of 8 years(0.5 to 18 years). One hundred and fourteen patients had prosthetic joint infection. Sixty nine were postoperative infection, 17 hematogenous and 28 undetermined infections. Incidence rates of the first 3 BMI were similar, but incidence rate of BMI of 35-39.9(HR=2.1,95% CI:1.1-4.3) was twice as that of BMI<35, and incidence rate of BMI≥40(HR=4.2,95% CI:1.8-9.7) was 4 times as that of BMI<35. Weight≥100 kg was identified as thresholds for increasing prosthetic joint infection(HR=2.1,95% CI:1.3-3.6) after primary total joint arthroplasty. Conclusion BMI≥35 or weight≥100 kg may serve as a index for higher perioperative antibiotic dosage.