髋关节脓毒性关节炎的治疗应该基于感染途径吗?

IF 1.8 Q3 INFECTIOUS DISEASES Journal of Bone and Joint Infection Pub Date : 2023-10-12 DOI:10.5194/jbji-8-209-2023
Fred Ruythooren, Stijn Ghijselings, Jordi Cools, Melissa Depypere, Paul De Munter, Willem-Jan Metsemakers, Georges Vles
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引用次数: 0

摘要

摘要背景:髋关节脓毒性关节炎(SA)的外科治疗旨在通过保留、切除或置换关节来治疗感染。在某些情况下,应尝试关节保留,而其他情况下将受益于立即关节切除或置换。人们提出了一些预后因素来指导决策。我们假设这些因素可以根据感染途径简化为三个亚群:连续传播,直接接种或血液播种。方法:我院16年来收治的41例自体髋关节SA患者均行手术治疗。研究了医疗记录,并整理了各种患者和疾病特征。结果:上述三个亚组导致的原髋关节SA患者在(1)健康水平、(2)髋关节状况、(3)微生物和(4)股骨头保存机会之间存在显著差异。在85%的患者中,股骨头切除术是必要的。未损伤髋关节的血液性感染患者有合理的机会(53%)避免关节切除术或置换术。46.3%的患者行髋关节置换术,感染率为10.5%。结论:由于连续扩散、血源性播种或直接接种导致的原髋关节SA患者有显著差异,应视为不同的临床实体。感染途径与股骨头保存的机会直接相关,因此应指导决策。只有先前健康髋关节发生血液性感染的患者才有可能保留股骨头。
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Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection?
Abstract. Background: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joint resection or replacement. Prognostic factors have been proposed to guide decision-making. We hypothesized that most of these factors can be simplified to three subgroups based on the route of infection: contiguous spreading, direct inoculation or hematogenous seeding. Methods: A total of 41 patients have been treated surgically for SA of the native hip at our tertiary hospital during the last 16 years. Medical records were studied, and various patient and disease characteristics were collated. Results: Significant differences between (1) level of fitness, (2) condition of the hip joint, (3) micro-organisms and (4) chance of femoral head preservation were found for patients with SA of the native hip resulting from the three aforementioned subgroups. Femoral head resection was necessary at one point in 85 % of patients. Patients with hematogenous infections of undamaged hips had a reasonable chance (53 %) of avoiding joint resection or replacement. Hip arthroplasty was performed on 46.3 % of patients, with an infection rate of 10.5 %. Conclusion: Patients with SA of the native hip resulting from contiguous spreading, hematogenous seeding or direct inoculation differ significantly and should be considered distinct clinical entities. Route of infection is directly related to the chance of femoral head preservation and should, therefore, guide decision-making. Only patients with hematogenous infection to a previously healthy hip had the possibility of femoral head preservation.
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来源期刊
CiteScore
3.70
自引率
0.00%
发文量
29
审稿时长
12 weeks
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