Byun Junwoo, Jung Min, Chung Kwangho, Jung Se-Han, Jang Hyeokjoo, Choi Chong-Hyuk, Kim Sung-Hwan
Arthroscopy and Joint Research Institute, Yonsei University College of Medicine, Seoul, Korea.
Department of Orthopedic Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Yonsei Med J. 2025 May;66(5):295-301. doi: 10.3349/ymj.2024.0190.
To identify the risk factors and effect of empirical glycopeptide on the failure of single arthroscopic debridement for septic knee arthritis in a native knee joint.
Patients who underwent arthroscopic debridement for septic knee arthritis from March 2005 to December 2022 at one institution were included in this study. Demographic data, comorbidities, preoperative factors including history of previous surgery, history of injection, laboratory data including preoperative C-reactive protein (CRP) and white blood cell (WBC) count, isolated pathogens from synovial fluid culture, and Gachter stage were analyzed. Statistical analyses using univariate and logistic regression were performed.
Out of 132 patients, 17 patients (12.9%) had more than one additional arthroscopic debridement. History of diabetes mellitus (DM) (<0.001), previous injection (=0.041), isolated in synovial fluid (=0.010), and high Gachter stage (=0.002) were identified as risk factors, whereas age, history of previous knee surgery at the affected knee, CRP level, preoperative WBC, and preoperative neutrophil count of synovial fluid had no significant relation. Logistic regression analysis showed significant increase of risk in patients with DM [odds ratio (OR) 12.002, 95% confidence interval (CI) 3.243-44.418, <0.001], previous injection history (OR 4.812, 95% CI 1.367-16.939, =0.017), and isolation of in synovial fluid (OR 4.804, 95% CI 1.282-18.001, =0.031) as independent risk factors for failure of infection eradication after single arthroscopic debridement.
Comorbidity of DM, history of previous injection, isolated in synovial fluid, and high Gachter stage were associated with a higher risk of failure to eradicate infection with a single arthroscopic procedure. Empirical glycopeptide administration also showed no significant benefit in reducing the risk of additional surgical procedures for infection control, suggesting against the routine administration of glycopeptide.
确定经验性使用糖肽类药物对初次膝关节关节镜清创术治疗化脓性膝关节炎失败的危险因素及影响。
本研究纳入了2005年3月至2022年12月在某机构接受化脓性膝关节炎关节镜清创术的患者。分析了人口统计学数据、合并症、术前因素（包括既往手术史、注射史）、实验室数据（包括术前C反应蛋白（CRP）和白细胞（WBC）计数）、滑膜液培养分离出的病原体以及加奇特分期。进行了单因素和逻辑回归统计分析。
132例患者中，17例（12.9%）接受了不止一次额外的关节镜清创术。糖尿病（DM）病史（<0.001）、既往注射史（=0.041）、滑膜液中分离出[病原体名称未给出]（=0.010）以及加奇特分期高（=0.002）被确定为危险因素，而年龄、患侧膝关节既往手术史、CRP水平、术前WBC以及滑膜液术前中性粒细胞计数无显著相关性。逻辑回归分析显示，DM患者[比值比（OR）12.002，95%置信区间（CI）3.243 - 44.418，<0.001]、既往注射史（OR 4.812，95% CI 1.367 - 16.939，=0.017）以及滑膜液中分离出[病原体名称未给出]（OR 4.804，95% CI 1.282 - 18.001，=0.031）作为初次关节镜清创术后感染根除失败的独立危险因素，其风险显著增加。
DM合并症、既往注射史、滑膜液中分离出[病原体名称未给出]以及加奇特分期高与单次关节镜手术根除感染失败的风险较高相关。经验性使用糖肽类药物在降低感染控制所需额外手术风险方面也未显示出显著益处，提示不建议常规使用糖肽类药物。
