摘要
目的探讨单中心十五年间膝关节翻修原因构成及变化,并分析不同翻修原因对假体生存时间、翻修手术时间和出血量的影响。方法回顾性分析2007年1月至2021年12月于北京大学人民医院骨关节科行初次膝关节翻修术的患者337例(345膝),男57例、女288例,年龄(69.3±8.6)岁(范围26~88岁)。统计分析345膝的翻修原因,并比较早期(术后2年内)与晚期(术后超过2年)、2012年以前与2012年以后的翻修原因构成。比较不同翻修原因的假体生存时间、手术时间、出血量的差异。结果345膝的翻修原因为假体周围感染133膝(38.6%),其次是无菌性松动97膝(28.1%)和关节不稳定35膝(10.1%)。早期翻修171膝(49.6%)中假体周围感染96膝(56.1%)最多,晚期翻修174膝(50.4%)中无菌性松动86膝(49.4%)最多。2012年以前翻修59膝,2012年以后翻修286膝,最常见的翻修原因均为假体周围感染,但2012年后因感染行翻修手术者(33.2%)较2012年前(64.4%)减少,差异有统计学意义(χ^(2)=18.790,P<0.001);2012年以前翻修原因中无菌性松动的构成比为15.3%,较2012年以后(30.8%)少,差异有统计学意义(χ^(2)=5.083,P=0.024)。纳入患者的中位假体生存时间为29个月,强直、髌骨并发症、假体周围感染患者的假体生存时间较短,聚乙烯磨损、无菌性松动患者的假体生存时间较长,不同生存时间的差异有统计学意义(P<0.001)。不同翻修原因组的手术时间和出血量的差异有统计学意义(P<0.001),因感染、无菌性松动行翻修手术的患者手术时间较长、出血量较大。结论假体周围感染是最常见的膝关节置换术后翻修原因,早期和晚期翻修最常见的原因分别为假体周围感染和无菌性松动;随着人工膝关节置换手术的推广与发展,翻修原因中假体周围感染的构成比呈下降趋势,而无菌性松动的构成比呈增高趋势。
Objective To assess causes for revision total knee arthroplasty(TKA)in China using the data of revision TKA in the past 15 years in our single center andcompare the differences in survival time,operation time and blood loss among different revision reasons.Methods Data of 337 patients(345 knees)with revision TKAs at our institution from January 2007 to December 2021(15 years)were retrospectively analyzed.The included population consists of 57 males and 288 females.The causes for first revision TKA were identified and compared according to the time of revision surgery as early(up to 2 years)and late revision(more than 2 years).The reason for revision before 2012 and after 2012 was also compared.Furthermore,the differences of survival time,operation time and blood loss among different revision reasons were compared.Results The most common reasons for revision of knee joints in 345 cases were periprosthetic infection(133 knees,38.6%),followed by aseptic loosening(97 knees,28.1%)and joint instability(35 knees,10.1%).Early revisions were performed in 171 knees(49.6%),while late revisions were performed in 174 knees(50.4%).Periprosthetic infection(96 knees,56.1%)and aseptic loosening(86 knees,49.4%)were the most common reasons for early and late revisions,respectively.There were 59 revisions performed before 2012 and 286 revisions performed after 2012,with periprosthetic infection being the main reason for revision in both groups.The percentage of revisions due to infection decreased from 64.4%before 2012 to 33.2%after 2012,and this difference was statistically significant(χ^(2)=18.790,P<0.001).The proportion of revisions due to aseptic loosening was 15.3%before 2012,which was significantly lower than the proportion of 30.8%after 2012(χ^(2)=5.083,P=0.024).The median survival time of the prostheses in the included patients was 30 months,with shorter survival time observed in patients with stiffness,patellar complications,and periprosthetic infection,and longer survival time observed in patients with polyethylene wear and aseptic loosening.There were significant differences in operation time and blood loss among different reasons for revision(P<0.001).Conclusion In our specialized arthroplasty center periprosthesis infection was the most common reason for revision.Periprosthesis infection and aseptic loosening needed to be considered for early or late-stage revision.With the development of technique of total knee arthroplasty,the proportion of periprosthesis infection is decreasing,while the incidence of aseptic loosening is increasing.
作者
靳健
张立毅
康武林
高轩
林剑浩
李志昌
Jin Jian;Zhang Liyi;Kang Wulin;Gao Xuan;Lin Jianhao;Li Zhichang(Arthritis Clinic and Research Center,Peking University People's Hospital,Beijing 100044,China;Department of Orthopaedics,Beijing Jishuitan Hospital,Capital Medical University,Beijing 100035,China;Department of Orthopaedics,Affiliated Hospital of Shaanxi University of Chinese Medicine,Xianyang 712000,China;Department of Joint Sports Medicine,Luanzhou People's Hospital,Luanzhou 063004,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第4期217-225,共9页
Chinese Journal of Orthopaedics
关键词
膝关节
再手术
假体相关感染
关节不稳定性
无菌性松动
Knee joint
Reoperation
Prosthesis-related infections
Joint instability
Aseptic loosening
