Teng H R, Fu H, Wu Y D, Guo Z K, An M Y, Yu K K, Wang Y T, Jia Q, Ma X H, Li C B
Department of Orthopedics, the Fourth Medical Center of Chinese PLA general hospital, Beijing 100048, China Chinese PLA Medical School, Beijing 100048, China.
Department of Orthopedics, the Fourth Medical Center of Chinese PLA general hospital, Beijing 100048, China.
Zhonghua Yi Xue Za Zhi. 2025 Aug 5;105(29):2483-2490. doi: 10.3760/cma.j.cn112137-20250415-00936.
To investigate the relationship between preoperative ultrasound-guided intra-articular local anesthetics injection at different time points and postoperative infection risk and inflammatory response after hip arthroscopy in femoroacetabular impingement(FAI). This retrospective observational study enrolled FAI patients who underwent hip arthroscopy surgery at the General Hospital of the People's Liberation Army from May 2017 to October 2023. According to the time interval between intra-articular injection and the surgery, the patients were divided into four groups: injection time≤30 days prior to surgery, injection time between 30-90 days prior to surgery, injection time>90 days prior to surgery, and non-injection group. The temperature and peripheral blood inflammation indicators of patients within one week before surgery and during hospitalization after surgery were collected. The international hip joint score (iHOT-12), visual analogue scale (VAS) of pain and the modified Harris Hip Score (mHHS) before and within 12 months after surgery were collected. The postoperative infection rates, clinical scores, temperature and inflammatory markers between groups were compared. A total of 425 patients were included, with 264 males and 161 females, aged (37.2±12.9) years. There were 152 cases in the≤30 d group, aged (36.9±12.5) years; 58 cases in the 30-90 d group, aged (41.4±13.2) years; 28 cases in the>90 d group, aged (37.3±12.0) years; and 187 cases in the non-injection group, aged (36.2±13.0) years. No acute and chronic infections were found in the enrolled patients, and 8 cases of suspected acute infections were found: 5 cases (2.7%) in the non-injection group, 2 cases (3.5%) in the 30-90 d group, 1 case (3.6%) in the>90 d group, and 0 case in the≤30 d group, and the difference in the proportion of patients with suspected acute infections among the various groups was not statistically significant (=0.061). There were 17 patients with maximum body temperature≥38.0 ℃ on postoperative day 1, 9 (4.8%) in the non-injection group, 2 (7.1%) in the > 90 d group, 1 (1.7%) in the 30-90 d group, and 5 (3.3%) in the≤30 d group. There were 143 patients with mildly elevated body temperature (37.0-38.0 ℃), 74 (39.6%) in the non-injection group, 10 (35.7%) in the>90 d group, 17 (29.3%) in the 30-90 d group, and 42 (27.6%) in the≤30 d group, and the difference in the proportion of the number of people with different degrees of fever among the groups was not statistically significant (=0.180). The peripheral blood leukocyte level was 10.6 (8.5, 12.2)×10/L in the≤30 d group, 9.7 (7.8, 10.5)×10/L in the 30-90 d group, 8.9 (8.0, 10.7)×10/L in the>90 d group, 10.0 (7.9, 11.3)×10/L in the non-injection group, and peripheral blood leukocytes in the≤30 d group were significantly higher than those in the other three groups (all <0.05). The differences in neutrophil ratio, neutrophil-to-lymphocyte ratio, C-reactive protein, erythrocyte sedimentation rate were not statistically significant among the groups after the surgery (all >0.05). The iHOT-12, VAS of pain and mHHS scores of patients in all groups improved at 12 months after surgery when compared with the values before the operation (all <0.001). Preoperative ultrasound-guided intra-articular hip anesthetic injection performed with standardized sterile technique does not increase postoperative infection risk or inflammatory response in FAI patients.
探讨术前超声引导下在不同时间点对股骨髋臼撞击症（FAI）患者行髋关节镜手术时进行关节腔内局部麻醉药注射与术后感染风险及炎症反应之间的关系。本回顾性观察性研究纳入了2017年5月至2023年10月期间在中国人民解放军总医院接受髋关节镜手术的FAI患者。根据关节腔内注射与手术的时间间隔，将患者分为四组：注射时间≤术前30天、注射时间在术前30 - 90天之间、注射时间>术前90天以及未注射组。收集患者术前一周内及术后住院期间的体温和外周血炎症指标。收集患者术前及术后12个月内的国际髋关节评分（iHOT - 12）、疼痛视觉模拟评分（VAS）和改良Harris髋关节评分（mHHS）。比较各组术后感染率、临床评分、体温和炎症标志物。共纳入425例患者，其中男性264例，女性161例，年龄（37.2±12.9）岁。≤30天组152例，年龄（36.9±12.5）岁；30 - 90天组58例，年龄（41.4±13.2）岁；>90天组28例，年龄（37.3±12.0）岁；未注射组187例，年龄（36.2±13.0）岁。纳入患者中未发现急慢性感染，发现8例疑似急性感染：未注射组5例（2.7%），30 - 90天组2例（3.5%），>90天组1例（3.6%），≤30天组0例，各组疑似急性感染患者比例差异无统计学意义（=0.061）。术后第1天体温≥38.0℃的患者有17例，未注射组9例（4.8%），>90天组2例（7.1%），30 - 90天组1例（1.7%），≤30天组5例（3.3%）。体温轻度升高（37.0 - 38.0℃）的患者有百43例，未注射组74例（39.6%），>90天组10例（35.7%），30 - 90天组17例（29.3%），≤30天组42例（27.6%），各组不同程度发热人数比例差异无统计学意义（=0.180）。≤30天组外周血白细胞水平为10.6（8.5，12.2）×10⁹/L，30 - 90天组为9.7（7.8，10.5）×10⁹/L，>90天组为8.9（8.0，10.7）×10⁹/L，未注射组为10.0（7.9，11.3）×10⁹/L，≤30天组外周血白细胞明显高于其他三组（均<0.05）。术后各组中性粒细胞比例、中性粒细胞与淋巴细胞比例、C反应蛋白、红细胞沉降率差异均无统计学意义（均>0.05）。与术前相比，所有组患者术后12个月时的iHOT - 12、疼痛VAS和mHHS评分均有所改善（均<0.001）。术前采用标准化无菌技术进行超声引导下髋关节腔内麻醉药注射不会增加FAI患者术后感染风险或炎症反应。
