中华关节外科杂志（电子版）
中華關節外科雜誌（電子版）
중화관절외과잡지（전자판）
CHINESE JOURNAL OF JOINT SURGERY(ELECTRONIC VERSION)
2014年
4期
502-508
,共7页
卓霞%胡逊%倪卫东%郭家勋%张怀先
卓霞%鬍遜%倪衛東%郭傢勛%張懷先
탁하%호손%예위동%곽가훈%장부선
人工关节置换术%感染%二期翻修%回归分析
人工關節置換術%感染%二期翻脩%迴歸分析
인공관절치환술%감염%이기번수%회귀분석
Prosthetic joint%Infection%Two-stage revisions%Multivariate analysis
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。
目的：分析人工關節置換術後假體週圍感染的病原學、臨床特徵，以及治療方法對患者預後的影響。方法採用迴顧性分析，查閱自2003年1月至2012年1月成渝某兩傢三甲醫院收治行人工關節（髖、膝和肘關節）置換術後髮生假體週圍感染的病例，瞭解患者感染的微生物特徵，患者的相關臨床指標和預後，併利用醫院電話隨訪平檯瞭解齣院患者的感染再髮生情況。用多因素迴歸方法瞭解對患者預後有影響的的危險因素，Kaplan-Meier生存分析二期翻脩對再髮感染的影響。結果10年中共穫得資料完整病例72例，髖、膝、肘關節手術分彆為26例、44例和2例。其中Ⅰ期置換56例，Ⅱ期置換16例。52.8％（38/72）患者齣現瞭晚期感染。膝關節是感染最常見的部位。金黃色葡萄毬菌（金葡菌）是最常見的感染病原菌（30.6％），其次是凝固酶陰性葡萄毬菌（19.4％）和鮑曼不動桿菌（8.7％）。對置換術後感染的治療總痊愈率為41.7％，其中二期翻脩的患者治愈率為（83.3％），其它治療方式的治愈率（36.7％）。兩者相比，有統計學差異（P＜0.01）。多因素迴歸分析顯示，二期翻脩是對患者預後有統計學意義的有益因素，Kaplan-Meier生存分析也顯示二期翻脩髮生感染複髮幾率顯著低于非二期翻脩組。結論金葡菌是引起人工關節置換術後感染最常見病原菌，二期翻脩是治療置換術後感染的適宜選擇。
목적：분석인공관절치환술후가체주위감염적병원학、림상특정，이급치료방법대환자예후적영향。방법채용회고성분석，사열자2003년1월지2012년1월성투모량가삼갑의원수치행인공관절（관、슬화주관절）치환술후발생가체주위감염적병례，료해환자감염적미생물특정，환자적상관림상지표화예후，병이용의원전화수방평태료해출원환자적감염재발생정황。용다인소회귀방법료해대환자예후유영향적적위험인소，Kaplan-Meier생존분석이기번수대재발감염적영향。결과10년중공획득자료완정병례72례，관、슬、주관절수술분별위26례、44례화2례。기중Ⅰ기치환56례，Ⅱ기치환16례。52.8％（38/72）환자출현료만기감염。슬관절시감염최상견적부위。금황색포도구균（금포균）시최상견적감염병원균（30.6％），기차시응고매음성포도구균（19.4％）화포만불동간균（8.7％）。대치환술후감염적치료총전유솔위41.7％，기중이기번수적환자치유솔위（83.3％），기타치료방식적치유솔（36.7％）。량자상비，유통계학차이（P＜0.01）。다인소회귀분석현시，이기번수시대환자예후유통계학의의적유익인소，Kaplan-Meier생존분석야현시이기번수발생감염복발궤솔현저저우비이기번수조。결론금포균시인기인공관절치환술후감염최상견병원균，이기번수시치료치환술후감염적괄의선택。
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 .
