术前口服抗菌药物对髋关节置换术后患者假体周围感染的影响

Effect of preoperative oral administration of antibiotics on infection around prosthesis after (hip) joint replacement

目的探究术前口服抗菌药物对髋关节置换术后假体周围感染(PJI)的影响。方法分析2017年1月-2020年1月在衢州市中医院行髋关节置换术的患者160例,根据术前是否口服了抗菌药物,将患者分为研究组和对照组,每组各80例。在术前24 h和术后24 h、3 d、1周测定患者外周血白细胞介素(IL)-1、IL-6、肿瘤坏死因子-α(TNF-α)、C-反应蛋白(CRP)和D-二聚体(D-D)、红细胞沉降率(ESR)和关节液白细胞计数(WBC)、中性粒细胞百分比(NEU)、CRP水平,并进行1年随访,分析患者感染及并发症状况,对PJI患者进行病原菌检测。结果术后24 h、术后3 d、术后1周研究组IL-6、IL-10、TNF-α均低于对照组(P<0.05);研究组患者血清CRP、血清D-D、ESR、关节液WBC、关节液NEU、关节液CRP低于对照组(P<0.05);随访时发现对照组患者中有9例下肢深静脉血栓(LDVT)5例PJI、1例其他感染,研究组出现了2例LDVT,研究组PJI和LDVT发生概率低于对照组(P<0.05);5例PJI患者中,单一感染3例、混合感染2例。结论术前口服抗菌药物确实能降低髋关节置换患者PJI风险,但需要对患者术前服用的剂量和周期做进一步研究。

OBJECTIVE To explore the effect of preoperative oral administration of antibiotics on periprosthetic infection(PJI) after hip replacement. METHODS A total of 160 patients who underwent hip replacement surgery in Quzhou Hospital of Traditional Chinese Medicine from Jan 2017 to Jan 2020 were enrolled in the study and divided into the study group and the control group according to the preoperative oral administration of antibiotics, with 80 cases in each group. The levels of peripheral blood interleukin(IL)-1, IL-6, tumor necrosis factor-α(TNF-α), C-reactive protein(CRP), D-dimer(D-D) and erythrocyte sedimentation rate(ESR) as well as the levels of joint fluid white blood cell(WBC), percentage of neutrophils(NEU) and CRP were determined 24 hours before the surgery and after the surgery for 24 hours, 3 days and 1 week, a one-year follow-up was conducted, the incidence of infections and complications was analyzed, and the pathogens were tested for the PJI patients. RESULTS The levels of IL-6, IL-10 and TNF-α of the study group were significantly lower than those of the control group after the surgery for 24 hours, 3 days and 1 week(P<0.05). The levels of serum CRP, serum D-D, joint fluid D-D, ESR, joint fluid WBC, joint fluid NEU and joint fluid CRP of the study group were significantly lower than those of the control group(P<0.05). The follow-up showed that there were 9 cases of deep vein thrombosis of lower extremity(LDVT), 5 cases of PJI and 1 case of other infections in the control group;there were 2 cases of LDVT in the study group;the incidence rates of PJI and LDVT of the study group were significantly lower than those of the control group(P<0.05). Among the 5 PJI patients, there were 3 cases of single infection and 2 cases of mixed infection. CONCLUSION The preoperative oral administration of antibiotics can actually reduce the risk of PJI in the hip replacement patients, however, it is necessary to further study the dosage and cycle of the preoperative administration.