Koyama Kensuke, Ohba Tetsuro, Ebata Shigeto, Haro Hirotaka
Orthopedics. 2016 May 1;39(3):e430-3. doi: 10.3928/01477447-20160404-05. Epub 2016 Apr 12.
Individuals with rheumatoid arthritis are at higher risk for infection than the general population, and surgical site infection after spinal surgery in this population can result in clinically significant complications. The goal of this study was to identify risk factors for acute surgical site infection after spinal surgery in patients with rheumatoid arthritis who were treated with nonbiologic (conventional) disease-modifying antirheumatic drugs (DMARDs) alone or with biologic DMARDs. All patients treated with biologic agents were treated with nonbiologic agents as well. The authors performed a retrospective, single-center review of 47 consecutive patients with rheumatoid arthritis who underwent spinal surgery and had follow-up of 3 months or longer. The incidence of surgical site infection was examined, and multivariate logistic regression analysis was performed to test the association of surgical site infection with putative risk factors, including the use of biologic agents, methotrexate, and prednisolone, as well as the duration of rheumatoid arthritis, the presence of diabetes, patient age, length of surgery, and number of operative levels. After spinal surgery, 14.89% (7 of 47) of patients had surgical site infection. Use of methotrexate and/or prednisolone, patient age, diabetes, duration of rheumatoid arthritis, length of surgery, number of operative levels, and use of biologic DMARDs did not significantly increase the risk of infection associated with spinal surgery. All patients who had surgical site infection had undergone spinal surgery with instrumentation. The findings show that greater attention to preventing surgical site infection may be needed in patients with rheumatoid arthritis who undergo spinal surgery with instrumentation. To the authors' knowledge, this is the first study to show that the use of biologic agents did not increase the incidence of surgical site infection after spinal surgery in patients with rheumatoid arthritis. [Orthopedics. 2016; 39(3):e430-e433.].
类风湿性关节炎患者比普通人群感染风险更高，该人群脊柱手术后手术部位感染可导致具有临床意义的并发症。本研究的目的是确定仅接受非生物（传统）改善病情抗风湿药物（DMARDs）或联合生物DMARDs治疗的类风湿性关节炎患者脊柱手术后急性手术部位感染的危险因素。所有接受生物制剂治疗的患者也同时接受了非生物制剂治疗。作者对47例连续接受脊柱手术且随访3个月或更长时间的类风湿性关节炎患者进行了一项回顾性单中心研究。检查手术部位感染的发生率，并进行多因素逻辑回归分析，以测试手术部位感染与假定危险因素的关联，这些因素包括生物制剂、甲氨蝶呤和泼尼松龙的使用，以及类风湿性关节炎的病程、糖尿病的存在、患者年龄、手术时长和手术节段数。脊柱手术后，14.89%（47例中的7例）的患者发生了手术部位感染。甲氨蝶呤和/或泼尼松龙的使用、患者年龄、糖尿病、类风湿性关节炎病程、手术时长、手术节段数以及生物DMARDs的使用并未显著增加与脊柱手术相关的感染风险。所有发生手术部位感染的患者均接受了器械辅助脊柱手术。研究结果表明，对于接受器械辅助脊柱手术的类风湿性关节炎患者，可能需要更加注重预防手术部位感染。据作者所知，这是第一项表明生物制剂的使用不会增加类风湿性关节炎患者脊柱手术后手术部位感染发生率的研究。[《骨科学》。2016年；39(3):e430 - e433。]
