氨甲环酸降低无菌翻修关节置换术后假体周围关节感染的发生率。
Tranexamic Acid Reduces the Rate of Periprosthetic Joint Infection After Aseptic Revision Arthroplasty.
机构信息
Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, Pennsylvania.
Orthopaedic Associates of Wisconsin, Pewaukee, Wisconsin.
出版信息
J Bone Joint Surg Am. 2020 Aug 5;102(15):1344-1350. doi: 10.2106/JBJS.19.00925.
BACKGROUND
Revision total joint arthroplasty (TJA) has a higher rate of periprosthetic joint infection (PJI) compared with primary TJA, possibly as the result of increased allogeneic blood transfusion. Tranexamic acid (TXA) is gaining popularity in revision TJA to minimize blood loss and the need for transfusion; however, its effect on PJI reduction has yet to be investigated. The hypothesis of this study was that the administration of TXA during revision arthroplasty is protective against subsequent PJI.
METHODS
A prospectively maintained institutional database was used to identify patients who underwent revision TJA for aseptic failure from 2009 to 2018 and had a minimum follow-up of 90 days. Patients who developed PJI following revision arthroplasty were identified. All patients with PJI met Musculoskeletal Infection Society (MSIS) criteria. A multivariate analysis was performed to identify variables independently associated with PJI after aseptic revision TJA.
RESULTS
Overall, 1,731 patients who underwent aseptic revision were identified; of these patients, 83 (4.8%) developed PJI. Patients who received TXA had significantly lower rates (p = 0.029) of PJI postoperatively at 3.30% compared with those who did not receive TXA at 5.73%. After controlling for relevant confounding variables, TXA remained a significant independent factor that protected against PJI (odds ratio [OR], 0.47 [95% confidence interval (CI), 0.23 to 0.90]; p = 0.030). Female sex was also identified as a significant independent factor that protected against PJI (OR, 0.52 [95% CI, 0.30 to 0.88]; p = 0.016). However, preoperative anemia was independently associated with an increased risk of subsequent PJI (OR, 2.37 [95% CI, 1.34 to 4.16]; p = 0.003).
CONCLUSIONS
Based on this study conducted at a single institution, the use of TXA during aseptic revision arthroplasty was independently associated with a reduced risk of subsequent acute PJI after adjusting for multiple patient characteristics and surgical factors.
LEVEL OF EVIDENCE
Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
背景
与初次全关节置换术（TJA）相比，翻修全关节置换术（TJA）的假体周围关节感染（PJI）发生率更高，这可能是由于异体输血增加所致。氨甲环酸（TXA）在翻修 TJA 中越来越受欢迎，可减少失血量和输血需求；然而，其减少 PJI 的效果尚未得到研究。本研究的假设是，在翻修关节置换术中使用 TXA 可预防随后发生 PJI。
方法
使用前瞻性维护的机构数据库，确定 2009 年至 2018 年期间因无菌性失败而行翻修 TJA 且随访时间至少为 90 天的患者。确定了在翻修关节置换术后发生 PJI 的患者。所有患有 PJI 的患者均符合肌肉骨骼感染协会（MSIS）标准。进行了多变量分析，以确定与无菌性翻修 TJA 后 PJI 相关的独立变量。
结果
总体而言，确定了 1731 例接受无菌性翻修的患者；其中 83 例（4.8%）发生 PJI。接受 TXA 的患者术后 PJI 发生率明显较低（p=0.029），为 3.30%，而未接受 TXA 的患者为 5.73%。在控制相关混杂变量后，TXA 仍然是预防 PJI 的显著独立因素（优势比[OR]，0.47[95%置信区间（CI），0.23 至 0.90]；p=0.030）。女性也是预防 PJI 的独立因素（OR，0.52[95%CI，0.30 至 0.88]；p=0.016）。然而，术前贫血与随后发生 PJI 的风险增加独立相关（OR，2.37[95%CI，1.34 至 4.16]；p=0.003）。
结论
基于在单一机构进行的这项研究，在调整多个患者特征和手术因素后，在无菌翻修关节置换术中使用 TXA 与随后发生急性 PJI 的风险降低独立相关。
证据水平
治疗性 III 级。请参阅作者说明，以获取完整的证据水平描述。
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