Luessenhop C P, Higgins L D, Brause B D, Ranawat C S
Hospital for Special Surgery, New York, New York, USA.
J Arthroplasty. 1996 Oct;11(7):862-8. doi: 10.1016/s0883-5403(96)80189-6.
The relative risk of age, sex, underlying diagnosis, corticosteroid usage, diabetes mellitus, and major nonprosthetic infection for the development of multiple prosthetic infections was assessed retrospectively. Deep infection occurred in 174 replacement arthroplasties in 145 patients between 1981 and 1993. Patients with rheumatoid arthritis had a significantly larger number of implants per patient (P < .001). Twenty-seven of 145 patients developed a second prosthetic infection, for an overall incidence of 19%. Of these 27, the underlying diagnoses were rheumatoid arthritis in 19, osteoarthritis in 6, neuropathic arthritis in 1, and systemic lupus erythematosus in 1. Rheumatoid arthritis and the occurrence of a major nonprosthetic infection (sepsis) were found to be highly associated with the development of a second prosthetic infection (P < .001 and P = .0001, respectively). In those rheumatoid patients with multiple infections, there was a significantly larger proportion with American Rheumatism Association class III and IV function than those with a single prosthetic infection (P = .0002). In 14 of the 27 cases of more than one prosthetic infection, the infected implants presented clinically within the same month. Ten of these 14 had an associated nonprosthetic infection. It is therefore not possible to accurately calculate the risk that one infected arthroplasty poses to other implants.
我们对年龄、性别、基础诊断、皮质类固醇使用情况、糖尿病以及严重非假体感染与发生多发性假体感染之间的相对风险进行了回顾性评估。1981年至1993年间，145例患者的174例置换关节成形术发生了深部感染。类风湿性关节炎患者的人均植入物数量显著更多（P <.001）。145例患者中有27例发生了第二次假体感染，总体发生率为19%。在这27例患者中，基础诊断为类风湿性关节炎的有19例，骨关节炎6例，神经性关节炎1例，系统性红斑狼疮1例。研究发现，类风湿性关节炎和严重非假体感染（败血症）的发生与第二次假体感染的发生高度相关（分别为P <.001和P =.0001）。在那些患有多发性感染的类风湿患者中，美国风湿病协会III级和IV级功能的患者比例明显高于单次假体感染患者（P =.0002）。在27例不止一次发生假体感染的病例中，有14例感染的植入物在临床上于同一个月内出现。这14例中有10例伴有非假体感染。因此，无法准确计算一个感染的关节成形术对其他植入物造成的风险。
