Gaine W J, Ramamohan N A, Hussein N A, Hullin M G, McCreath S W
Department of Orthopaedics, Southern General Hospital, Glasgow, Scotland, UK.
J Bone Joint Surg Br. 2000 May;82(4):561-5. doi: 10.1302/0301-620x.82b4.10305.
We have studied prospectively the outcome of wound discharge in patients after arthroplasty of the hip and knee. Over a period of 3.5 years 530 primary arthroplasties were carried out in one hospital. Postoperative wound infections developed in 82. At a mean follow-up of two years a comparison was made between these patients and 82 with healthy wounds, in terms of symptoms and signs of deep infection. There was an incidence of 1.1% of early deep infection, within six weeks in all cases. The rate of 'superficial' infection was 17.3% in the hips, 10.5% in the knees and 14.3% in total. At a mean follow-up of 26 months, there were no significant differences between the patients with infected wounds and a matched group of patients with healthy wounds in terms of the ESR, level of C-reactive protein, white cell count and radiological scores, but clinical scores were significantly worse in the patients with infected knees (p < 0.05). The length of stay was also significantly longer in this group (mean 14.6 days in the healthy wound group, 19 days in the problem group; p < 0.005). There was, however, no convincing evidence that these wound infections led to deep infection and early revision in the early to medium follow-up period. A larger and longer prospective trial would be necessary to shed more light on this potential problem.
我们对髋膝关节置换术后患者伤口引流的结果进行了前瞻性研究。在3.5年的时间里，一家医院共进行了530例初次关节置换手术。其中82例出现了术后伤口感染。在平均两年的随访期内，对这些患者与82例伤口健康的患者在深部感染的症状和体征方面进行了比较。所有病例中，早期深部感染的发生率为1.1%，均发生在六周内。“浅表”感染率在髋关节置换患者中为17.3%，膝关节置换患者中为10.5%，总体为14.3%。在平均26个月的随访期内，伤口感染患者与配对的伤口健康患者在血沉、C反应蛋白水平、白细胞计数和放射学评分方面无显著差异，但感染膝关节的患者临床评分明显更差（p<0.05）。该组患者的住院时间也明显更长（伤口健康组平均为14.6天，问题组为19天；p<0.005）。然而，没有令人信服的证据表明这些伤口感染在早期至中期随访期内会导致深部感染和早期翻修。需要进行更大规模、更长时间的前瞻性试验，以更清楚地了解这一潜在问题。
