带间隔器生存可作为慢性PJI中无法耐受二期翻修病例的可选方案——一项单中心队列研究

Survival with spacer can be used as an alternative for patients with chronic PJI who cannot tolerate two-stage revision--A single center cohort study

目的评估慢性人工关节感染(PJI)带间隔器生存病例与完成二期翻修方案病例的临床疗效差异。方法回顾性收集2014年至2022年因慢性人工关节感染在我中心接受治疗的患者资料,按最终治疗方案分为带间隔器生存病例(DJS)与完成二期翻修方案病例(TSR)的队列;DJS组中根据植入间隔器类型不同分为骨水泥型(CS)和假体型(PS)。记录患者的年龄、性别、体重指数、实验室检测结果、术前术后关节功能评分、疼痛视觉模拟评分,比较DJS组和TSR组患者的感染控制率、并发症发生率。结果共纳入98例诊断为慢性PJI的患者,年龄为(65.14±9.88)岁(32~88岁);DJS组35例,TSR组63例,所有患者至少随访1年(平均52.68±26.07个月)。在感染控制率方面,DJS组有5例复发感染(14.28%),TSR组有6例复发感染(9.52%),感染控制率差异无统计学意义(P=0.474)。功能方面,TSR组术后关节功能评分高于DJS组,然而在随访中DJS组患者对患肢的功能满意度(65.71%)和TSR组(66.67%)并没有显著差异(P=0.924)。并发症方面,DJS组术后出现假体断裂2例,关节脱位4例,关节假体周围骨折2例,深静脉血栓形成2例;TSR组2例假体周围骨折,2例脱位和2例下肢深静脉血栓形成,DJS组并发症发生率高于TSR组(P=0.015);而DJS组中PS病例的并发症低于CS病例(P=0.009),与TSR组无显著差异(P=0.388)。结论DJS组与TSR组的感染控制率相似、功能接近,当患者无法耐受或无意愿进行二期翻修时,带间隔器生存尤其是假体型间隔器可作为部分慢性PJI患者的最终治疗选择。

Objective To evaluate the clinical outcomes of patients with chronic Periprosthetic Joint Infection(PJI)who survived with spacer and those who underwent two-stage revision.Methods The data of patients with chronic PJI treated in our center from 2014 to 2022 were retrospectively collected.According to the final treatment plan,the patients were divided into Destination Joint Spacers(DJS)and Two-Stage Revision(TSR).DJS group was divided into Cement spacer(CS)and Prosthetic spacer(PS)according to the different types of implanted spacer.The patient's age,gender,body mass index,laboratory test results,preoperative and postoperative joint function scores,and visual analogue scale(VAS)of pain were recorded.The infection control rate and complication rate were compared between the DJS group and the TSR group.Results A total of 98 patients with chronic PJI were enrolled,with an average age of 65.14±9.88 years(range,32-88 years).There were 35 patients in the DJS group and 63 patients in the TSR group.All patients were followed up for at least 1 year(mean 52.68±26.07 months).In terms of infection control rate,there were 5 cases(14.28%)of recurrent infection in the DJS group and 6 cases(9.52%)in the TSR group.There was no significant difference in infection control rate between the two groups(P=0.474).In terms of function,the postoperative joint function score of the TSR group was higher than that of the DJS group.However,there was no significant difference in functional satisfaction of the affected limb between the patients in the DJS group(65.71%)and TSR group(66.67%)during follow-up(P=0.924).In terms of complications,there were 2 cases of prosthesis fracture,4 cases of joint dislocation,2 cases of periprosthetic joint fracture,and 2 cases of deep vein thrombosis in DJS group.There were 2 cases of periprosthetic fracture,2 cases of dislocation and 2 cases of deep vein thrombosis in the TSR group.The incidence of complications in the DJS group was higher than that in the TSR group(P=0.015).In the DJS group,the PS group had a significantly lower incidence of complications than the CS group(P=0.009),and there was no significant difference between the PS group and the TSR group(P=0.388).Conclusions DJS group and TSR group have similar infection control rates and functional outcomes.When patients cannot tolerate or are unwilling to undergo two-stage revision,survival with spacer,especially prosthetic spacer,can be the final treatment option for some patients with chronic PJI.