人工关节置换术后感染的临床及预后分析

目的分析人工关节置换术后假体周围感染的病原学、临床特征,以及治疗方法对患者预后的影响。方法采用回顾性分析,查阅自2003年1月至2012年1月成渝某两家三甲医院收治行人工关节（髋、膝和肘关节）置换术后发生假体周围感染的病例,了解患者感染的微生物特征,患者的相关临床指标和预后,并利用医院电话随访平台了解出院患者的感染再发生情况。用多因素回归方法了解对患者预后有影响的的危险因素,Kaplan-Meier生存分析二期翻修对再发感染的影响。结果 10年中共获得资料完整病例72例,髋、膝、肘关节手术分别为26例、44例和2例。其中Ⅰ期置换56例,Ⅱ期置换16例。52.8%（38/72）患者出现了晚期感染。膝关节是感染最常见的部位。金黄色葡萄球菌（金葡菌）是最常见的感染病原菌（30.6%）,其次是凝固酶阴性葡萄球菌（19.4%）和鲍曼不动杆菌（8.7%）。对置换术后感染的治疗总痊愈率为41.7%,其中二期翻修的患者治愈率为（83.3%）,其它治疗方式的治愈率（36.7%）。两者相比,有统计学差异（P〈0.01）。多因素回归分析显示,二期翻修是对患者预后有统计学意义的有益因素,Kaplan-Meier生存分析也显示二期翻修发生感染复发几率显著低于非二期翻修组。结论金葡菌是引起人工关节置换术后感染最常见病原菌,二期翻修是治疗置换术后感染的适宜选择。

Study on clinical feature and outcomes of prosthetic joint infection

Objective To understand the etiology and clinical characteristics of the prosthetic joint infection （PJI）, and the outcomes of different treatment strategies .Methods A retrospective study was employed to collect all the cases of prosthetic joint infection in two teaching hospitals between January 2003 and January 2012.The patients′characteristics, microbiology and outcomes were recorded , and the conditions of the recurrent infection were obtained from telephone follow-up.The impact factor of the outcome of prosthetic joint infection was learned by the multiple logistic regression method , and the influence of two-stage revision on the incidence of the recurrent infection was evaluated by Kaplan-Meier plot analysis .Results 72 patients were diagnosed as prosthetic joint infection and analyzed according to the study design, including 26 cases of THA, 44 cases of TKA, and two cases of TEA.77.8%（56/72） patients had primary revision prosthesis and 52.8%（38/72） patients had a late prosthesis joint infection . The knee was the most commonly infected site .Staphylococcus aureus was the most common pathogen （30.6%）, followed by coagulase-negative staphylococci （19.4%）, and acinetobacter （8.7%）.The overall treatment success rate was 41.7%.The patients who received a two-stage revision had a better outcome, compared to the patients who underwent other types of surgeries （ 83.3% vs.33.3%, respectively;P〈0.01 ） .In the multivariate analysis , the two-stage revision was significantly associated with the treatment success （ P〈0.01 ） .In Kaplan-Meier plot analysis , the recurrent infection incidence was also less in the patients who received the two-stage revision .Conclusion This study demonstrates that staphylococcus aureus is the most common pathogen in PJI .Two-stage revision is significantly associated with a better outcome .