Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, PR China.
Department of Orthopaedic Surgery, Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China; Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, PR China.
J Hosp Infect. 2015 Feb;89(2):82-9. doi: 10.1016/j.jhin.2014.10.008. Epub 2014 Dec 4.
Many of the mooted risk factors associated with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) remain controversial and are not well characterized. Online and manual searches were performed using Medline, Embase, Chinese National Knowledge Infrastructure and the Cochrane Central Database from January 1980 to March 2014). For inclusion, studies had to meet the quality assessment criteria of the CONSORT statement, and be concerned with evaluation of risk factors for PJI after TJA. Two reviewers extracted the relevant data independently and any disagreements were resolved by consensus. Fourteen studies were included in this meta-analysis. The following significant risk factors for PJI were identified: body mass index (both continuous and dichotomous variables); diabetes mellitus; corticosteroid therapy; hypoalbuminaemia; history of rheumatoid arthritis; blood transfusion; presence of a wound drain; wound dehiscence; superficial surgical site infection; coagulopathy; malignancy, immunodepression; National Nosocomial Infections Surveillance Score ≥2; other nosocomial infection; prolonged operative time; and previous surgery. Factors that were not significantly associated with PJI were: cirrhosis; hypothyroidism; urinary tract infection; illicit drug abuse; alcohol abuse; hypercholesterolaemia; hypertension, ischaemic heart disease; peptic ulcer disease; hemiplegia or paraplegia; dementia; and operation performed by a staff surgeon (vs a trainee). Strategies to prevent PJI after TJA should focus, in particular, on those patients at greatest risk of infection according to their individual risk factors.
许多与全关节置换术后假体周围关节感染（PJI）相关的推测风险因素仍然存在争议，并且尚未得到很好的描述。从 1980 年 1 月至 2014 年 3 月，我们使用 Medline、Embase、中国国家知识基础设施和 Cochrane 中央数据库进行了在线和手动搜索。纳入标准为：研究必须符合 CONSORT 声明的质量评估标准，并且关注全关节置换术后 PJI 的风险因素评估。两位评审员独立提取相关数据，任何分歧均通过共识解决。共有 14 项研究纳入本 meta 分析。确定以下 PJI 的显著危险因素：体重指数（连续和二分变量）；糖尿病；皮质类固醇治疗；低白蛋白血症；类风湿关节炎病史；输血；存在伤口引流管；伤口裂开；浅表手术部位感染；凝血功能障碍；恶性肿瘤，免疫抑制；国家医院感染监测评分≥2；其他医院感染；手术时间延长；既往手术史。与 PJI 无显著相关的因素包括：肝硬化；甲状腺功能减退症；尿路感染；药物滥用；酒精滥用；高胆固醇血症；高血压，缺血性心脏病；消化性溃疡病；偏瘫或截瘫；痴呆；以及由主治医生（而非实习医生）进行的手术。预防全关节置换术后 PJI 的策略应特别针对那些根据个体危险因素感染风险最大的患者。
