前交叉韧带重建术后感染危险因素的系统评价与Meta分析
A Systematic Review and Meta-analysis of Risk Factors for an Infection After Anterior Cruciate Ligament Reconstruction.
作者信息
Zhang Lei, Yang Runze, Mao Yunhe, Fu Weili
机构信息
Orthopedics Research Institute, Department of Orthopedic Surgery, West China Hospital, Sichuan University, Chengdu, China.
出版信息
Orthop J Sports Med. 2023 Oct 13;11(10):23259671231200822. doi: 10.1177/23259671231200822. eCollection 2023 Oct.
BACKGROUND
Identifying risk factors for an infection after anterior cruciate ligament reconstruction (ACLR) and following targeted preventive strategies can effectively reduce this potentially serious complication.
PURPOSE
To perform a systematic review and meta-analysis to identify the risk factors for an infection after ACLR.
STUDY DESIGN
Systematic review; Level of evidence, 4.
METHODS
The PubMed, Embase, and Web of Science databases were searched from inception to September 1, 2022, for prospective and retrospective studies investigating risk factors for any type of infection after ACLR. Odds ratios (ORs) or mean differences were calculated for potential risk factors if ≥2 studies assessed the same risk factor. A qualitative analysis of variables was performed if a meta-analysis could not be conducted.
RESULTS
A total of 17 studies with 141,991 patients were included in this review. The overall pooled infection rate was 0.86% (range, 0.24%-5.50%). There were 20 risk factors identified for analysis. Of these, 7 variables independently increased the odds of an infection after ACLR: (1) male sex (OR, 1.90 [95% CI, 1.33-2.73]), (2) diabetes (OR, 2.69 [95% CI, 1.66-4.35]), (3) hamstring tendon autograft (OR, 2.51 [95% CI, 2.03-3.10]), (4) revision ACLR (OR, 2.31 [95% CI, 1.22-4.37]), (5) professional athlete status (OR, 6.21 [95% CI, 1.03-37.38]), (6) lateral tenodesis (OR, 3.45 [95% CI, 1.63-7.28]), and (7) corticosteroid use (OR, 7.83 [95% CI, 3.68-16.63]). No significant associations were found between postoperative infections and age, body mass index, smoking, meniscal repair, or outpatient surgery.
CONCLUSION
This review revealed that an increased risk of infections after ACLR was associated with male sex, diabetes, hamstring tendon autograft, revision surgery, professional athlete status, lateral tenodesis, and steroid use. Knowledge of the risk factors associated with an infection after ACLR may facilitate the identification of high-risk cases and the implementation of preventive measures to mitigate the serious consequences of this complication.
背景
识别前交叉韧带重建（ACLR）术后感染的危险因素并采取针对性的预防策略，可有效降低这一潜在的严重并发症。
目的
进行系统评价和荟萃分析，以确定ACLR术后感染的危险因素。
研究设计
系统评价；证据等级，4级。
方法
检索PubMed、Embase和Web of Science数据库，检索时间从建库至2022年9月1日，纳入调查ACLR术后任何类型感染危险因素的前瞻性和回顾性研究。如果≥2项研究评估了同一危险因素，则计算其比值比（OR）或均值差。若无法进行荟萃分析，则对变量进行定性分析。
结果
本评价共纳入17项研究，涉及141,991例患者。总体合并感染率为0.86%（范围为0.24%-5.50%）。共确定了20个危险因素进行分析。其中，7个变量独立增加了ACLR术后感染的几率：（1）男性（OR，1.90[95%CI，1.33-2.73]），（2）糖尿病（OR，2.69[95%CI，1.66-4.35]），（3）腘绳肌腱自体移植（OR，2.51[95%CI，2.03-3.10]），（4）翻修ACLR（OR，2.31[95%CI，1.22-4.37]），（5）职业运动员身份（OR，6.21[95%CI，1.03-37.38]），（6）外侧腱固定术（OR，3.45[95%CI，1.63-7.28]），以及（7）使用皮质类固醇（OR，7.83[95%CI，3.68-16.63]）。未发现术后感染与年龄、体重指数、吸烟、半月板修复或门诊手术之间存在显著关联。
结论
本评价表明，ACLR术后感染风险增加与男性、糖尿病、腘绳肌腱自体移植、翻修手术、职业运动员身份、外侧腱固定术和类固醇使用有关。了解ACLR术后感染的相关危险因素，可能有助于识别高危病例并实施预防措施，以减轻这一并发症的严重后果。
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