全髋关节置换术后假体周围关节感染治疗中一期翻修与二期翻修的比较再感染率：一项荟萃分析
Comparative reinfection rate of one-stage versus two-stage revision in the management of periprosthetic joint infection following total hip arthroplasty: a meta-analysis.
作者信息
Qin Yueying, Liu Zeshou, Li Liwen, Yang Yuxing, Huang Xiaomeng, Liang Weiming, Lin Longbao
机构信息
The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology, 124 Yuejin Road, Liuzhou, Guangxi Province, 545001, China.
出版信息
BMC Musculoskelet Disord. 2024 Dec 20;25(1):1056. doi: 10.1186/s12891-024-08199-y.
BACKGROUND
Debates persist on the optimal surgical approach for treating Periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This meta-analysis aimed to compare the reinfection rate of one-stage revision versus two-stage revision for PJI after THA.
METHODS
A comprehensive search was performed in four databases (PubMed, Embase, Web of Science, and Cochrane Library) to locate articles that assessed the reinfection rate of one-stage revision compared to two-stage revision. Meta-analyses of reinfection rate were performed.
RESULTS
A total of 14 articles including of 1429 patients were chosen for inclusion in this meta-analysis, with 561 patients in the one-stage group and 868 patients in the two-stage group. The meta-analysis of the 14 trials revealed that there was no statistically significant disparity in the reinfection rate between the two groups(OR = 1.34, 95% CI 0.92 ~ 1.93, P = 0.12, I = 0). A subgroup analysis was conducted based on the presence of a well-defined algorithm for decision making in either a one-stage or two-stage revision. There was no statistically significant difference in reinfection rate between one-stage and two-stage revision if there was a decision algorithm(OR = 0.83, 95% CI 0.44 ~ 1.54, P = 0.55, I = 0). If not, the reinfection rate of one-stage revision was significantly higher than that of two-stage revision(OR = 1.79, 95% CI 1.11 ~ 2.88, P = 0.02, I = 0). Postoperative hip function score was significantly better in the one-stage revision group than that of the two-stage revision group(SMD = 0.54, 95% CI 0.31 ~ 0.78, P<0.05, I = 79%).
CONCLUSIONS
A strategy that is clearly defined and can be used for decision making in one-stage or two-stage revision is necessary for the treatment of PJI after THA. When there is significant damage to the soft tissue and/or the presence of strong microorganisms, a two-stage revision is recommended in order to decrease the reinfection rate. One-stage revision is recommended for patients with low-toxic infections and intact soft tissue.
TRIAL REGISTRATION
PROSPERO (CRD42023450842, 17 August 2023) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450842 .
背景
关于全髋关节置换术（THA）后假体周围关节感染（PJI）的最佳手术方法仍存在争议。本荟萃分析旨在比较THA后PJI一期翻修与二期翻修的再感染率。
方法
在四个数据库（PubMed、Embase、Web of Science和Cochrane图书馆）中进行全面检索，以查找评估一期翻修与二期翻修再感染率的文章。对再感染率进行荟萃分析。
结果
本荟萃分析共纳入14篇文章，涉及1429例患者，其中一期翻修组561例，二期翻修组868例。对14项试验的荟萃分析显示，两组之间的再感染率无统计学显著差异（OR = 1.34，95% CI 0.92至1.93，P = 0.12，I = 0）。根据一期或二期翻修中是否存在明确的决策算法进行亚组分析。如果有决策算法，一期翻修与二期翻修的再感染率无统计学显著差异（OR = 0.83，95% CI 0.44至1.54，P = 0.55，I = 0）。如果没有，一期翻修的再感染率显著高于二期翻修（OR = 1.79，95% CI 1.11至2.88，P = 0.02，I = 0）。一期翻修组术后髋关节功能评分显著优于二期翻修组（SMD = 0.54，95% CI 0.31至0.78，P < 0.05，I = 79%）。
结论
THA后PJI的治疗需要一种明确的、可用于一期或二期翻修决策的策略。当软组织有严重损伤和/或存在强毒力微生物时，建议采用二期翻修以降低再感染率。对于低毒感染且软组织完整的患者，建议一期翻修。
试验注册
PROSPERO（CRD42023450842，2023年8月17日）https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023450842 。
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