一期和二期髋关节翻修术后感染复发率的Meta分析

Meta analysis on re-infection following one and two stage revisions of infected total hip arthroplasty

目的比较一期和二期翻修术治疗全髋关节置换术(THA)后感染的感染复发率。方法在Pubmed、EMBase和Medline(1988年1月到2017年1月) 3个数据库进行检索。收集THA术后感染行一期和二期翻修的文章。筛选符合预先设定标准(一期翻修与二期翻修对照治疗全髋关节置换术后感染,排除非对照研究)的文章,提取手术例数及感染复发例数进行Meta分析。采用Review Manager5. 3软件统计分析感染复发率。结果初检1 084篇,最终纳入10篇。THA术后感染总共1 116例,其中一期翻修480例,二期翻修636例;一期和二期的感染复发率对比结果为[OR=1. 40,95%CI(0. 92,2. 15),P=0. 12]。如果将软组织情况良好、骨缺损少、致病菌明确且对药物敏感作为一期翻修的选择条件,一期和二期翻修的感染复发率相似,结果无统计学意义[OR=0. 44,95%CI(0. 13,1. 41),P=0. 17];对于THA术后感染,如果不考虑软组织、骨缺损、致病菌的情况下行翻修手术,二期翻修的感染复发率比一期低,结果具有统计学意义[OR=1. 79,95%CI(1. 11,2. 88),P=0. 02]。结论对于THA术后感染的治疗,局部条件良好与否会影响一期和二期翻修术后感染复发率。

Objective To compare the re-infection of infected total hip arthroplasty( THA) treated by one stage revision and two sate revision. Methods The papers about THA treated by one stage and two stage revision were searched on Pubmed、Medline and EMBase data( January,1988 to Jananuary,2017).The papers were selected according to the criteria( the papers about THA treated by one stage and two stage revisions,excluding treated by single treatment). The re-infection rate was analysed by meta-analysis. Review Manger 5. 3 was used for data analysis. Results Ten articles were collected from 1 084 articles finally.1 116 cases infected THA were studied,which 480 cases were treated by one-stage revision and 636 cases were treated by two-stage revision. Re-infection rate between the two group results shows(OR = 1. 40,95% CI( 0. 92,2. 15),P = 0. 12)If the soft tissue was healthy、the bone defect was small and the pathogen was determined,the re-infection rates were similar between one stage and two stage revisions[OR = 0. 44,95% CI( 0. 13,1. 41),P = 0. 17];If the soft tissue、bone defects and pathogens were not considered,the difference in the re-infection rate was statistically significant [OR = 1. 79,95% CI( 1. 11,2. 88),P = 0. 02].Conclusion In the treatment of the infected total hip arthroplasty,the local condition may influence the reinfection rate of one-stage and two stage revision surgery.