术前 1 个月内行皮质类固醇注射与全肩关节置换术后假体周围关节感染的风险增加相关。
Pre-operative corticosteroid injection within 1 month of total shoulder arthroplasty is associated with increased risk of periprosthetic joint infection.
机构信息
Department of Orthopaedic Surgery and Rehabilitation Medicine, Downstate Medical Center, State University of New York (SUNY), 450 Clarkson Avenue, MSC 30, Brooklyn, NY, 11203, USA.
Lifebridge Health, Sinai Hospital of Baltimore, Rubin Institute for Advanced Orthopedics, Baltimore, MD, USA.
出版信息
Arch Orthop Trauma Surg. 2023 Sep;143(9):5609-5614. doi: 10.1007/s00402-023-04866-2. Epub 2023 Apr 14.
INTRODUCTION
Corticosteroid injections (CSI) may increase the risk of peri-prosthetic infections (PJI) following total shoulder arthroplasty (TSA). Our study specifically assessed the risk of PJI in patients who received CSI: (1) less than 4 weeks prior to TSA; (2) 4-8 weeks prior to TSA; and (3) 8-12 weeks prior to TSA.
MATERIALS AND METHODS
A national all-payer database was queried to identify patients who underwent TSA with a shoulder osteoarthritis diagnosis from October 1, 2015 to October 31, 2020 (n = 25,422). There were four cohorts: CSI within 4 weeks of TSA (n = 214), CSI 4-8 weeks prior to TSA (n = 473), CSI 8-12 weeks prior to TSA (n = 604), and a control cohort that did not receive CSI (n = 15,486). Bivariate chi-square analyses of outcomes were performed in addition to multivariate regression.
RESULTS
A significant increase in PJI risk at 1 year (Odds Ratio [OR] = 2.29, 95% Confidence Interval [CI] = 1.19-3.99, p = 0.007) and 2 years (OR = 2.03, CI = 1.09-3.46, p = 0.016) in patients who received CSI within 1 month of TSA was noted. PJI risk was not significantly increased at any time point for patients who received a CSI greater than 4 weeks prior to TSA (all p ≥ 0.396).
CONCLUSION
PJI risk is increased at both 1 and 2 years post-operatively in patients who received a CSI within 4 weeks of TSA. Therefore, TSA should be deferred at least 4 weeks after a patient receives a CSI to mitigate PJI risk.
LEVEL OF EVIDENCE
Level III.
引言
皮质类固醇注射（CSI）可能会增加全肩关节置换术后（TSA）发生假体周围感染（PJI）的风险。我们的研究专门评估了接受 CSI 的患者发生 PJI 的风险：（1）在 TSA 前不到 4 周；（2）在 TSA 前 4-8 周；和（3）在 TSA 前 8-12 周。
材料和方法
使用全国所有支付者数据库，从 2015 年 10 月 1 日至 2020 年 10 月 31 日，对接受肩关节炎诊断的 TSA 患者进行了查询（n=25422）。有四个队列：在 TSA 前 4 周内接受 CSI（n=214）、在 TSA 前 4-8 周内接受 CSI（n=473）、在 TSA 前 8-12 周内接受 CSI（n=604）和未接受 CSI 的对照组（n=15486）。除了多元回归外，还进行了结果的双变量卡方分析。
结果
在 TSA 后 1 年（优势比 [OR] = 2.29，95%置信区间 [CI] = 1.19-3.99，p=0.007）和 2 年（OR=2.03，CI=1.09-3.46，p=0.016）时，接受 TSA 前 1 个月内接受 CSI 的患者发生 PJI 的风险显著增加。对于接受 CSI 大于 4 周前的患者，在任何时间点都没有明显增加 PJI 风险（所有 p≥0.396）。
结论
在接受 TSA 前 4 周内接受 CSI 的患者，在术后 1 年和 2 年时 PJI 风险增加。因此，为了降低 PJI 风险，应至少在患者接受 CSI 后 4 周再进行 TSA。
证据水平
III 级。
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