是否需要在注射糖皮质激素后等待3个月再进行TKA？

Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty?

我们是否需要在注射糖皮质激素后等待3个月

以减少全膝关节置换术后感染的风险?

译者：沈松坡

Background: Corticosteroid injections administered within 3 months before total knee arthroplasty (TKA) have been linked to increased risk of postoperative infection. However, it would be beneficial to further delineate the timing of injections to determine whether a narrower window exists for safe administration of corticosteroid injections. The purposes of our study were to (1) determine whether there were a different time frame between corticosteroid injection and primary TKA that increased infection risk and (2) determine risk factors associated with infection after TKA.

背景: 全膝关节置换术(TKA)前3个月内给予糖皮质激素注射与术后感染风险增加相关。然而，进一步确定注射的时间是有益的，以确定糖皮质激素的注射是否存在一个更窄的安全窗口期。我们研究的目的是:(1)确定糖皮质激素注射和初次TKA感染风险增加之间是否有不同的时间框架;(2)确定TKA后与感染相关的危险因素。

Methods: TKA patients were identified from a national database from 2007 to 2017 and stratified based on their history of corticosteroid injections within the 6-month preoperative period. Patients who received injections were stratified into biweekly cohorts by the timing of their most recent injection. The 1-year rate of postoperative infection treated by surgical débridement was compared between injection and noninjection cohorts. Univariate logistic regressions of risk factors and a multivariate analysis for patient comorbidities and injection cohorts associated with increased infection risk were conducted.

方法: 从2007年至2017年的国家数据库中识别TKA患者，并根据术前6个月的糖皮质激素注射史进行分层。接受注射的患者根据他们最近一次注射的时间以两周为一组。将注射组和非注射组术后1年的感染清创治疗手术情况进行组件比较。对风险因素进行单因素logistic回归分析，并对与感染风险增加相关的患者共患病和注射队列进行多因素分析。

Results: In the 76,090 TKA patients identified, corticosteroid injection within 2 weeks before TKA increased the risk of postoperative infection (P = 0.02) and injections within 2 to 4 weeks trended toward increased infection in univariate regression. No significant differences were observed in any other injection time frames. In the multivariate analysis, injections within 2 weeks before TKA were identified as an independent risk factor (odds ratio: 2.89; P = 0.04) for postoperative infection. Additional risk factors included chronic obstructive pulmonary disease, coronary artery disease, diabetes, ischemic heart disease, obesity, rheumatoid arthritis, and tobacco, whereas female sex and patient aged older than 65 were protective.

结果: 在确认的76,090例TKA患者中，TKA前2周内注射糖皮质激素增加了术后感染的风险(P = 0.02)，在单因素回归分析中，2 ~ 4周内注射糖皮质激素有增加感染的趋势。在其他任何注射时间框架中没有观察到显著差异。多因素分析中，TKA前2周内注射为独立危险因素(比值比:2.89;P = 0.04)。其他危险因素包括慢性阻塞性肺病、冠状动脉疾病、糖尿病、缺血性心脏病、肥胖、类风湿关节炎和吸烟，而性别为女和年龄65岁以上对患者具有保护性。

Discussion: Our results suggest that TKA performed within four weeks of a corticosteroid injection may be associated with a higher risk of postoperative infection; however, delaying surgery more than four weeks may not provide additional infection risk reduction. Further prospective randomized studies are needed to determine the optimal timing of TKA after corticosteroid injections.

讨论: 我们的结论表明，在注射糖皮质激素后四周内进行TKA可能与术后感染风险升高相关；然而，推迟手术超过4周可能不会进一步降低感染风险。需要进一步的前瞻性随机研究来确定糖皮质激素注射后TKA的最佳时机。

文献出处：Bhattacharjee S, Wallace S, Luu HH, Shi LL, Lee MJ, Chen AF. Do We Need to Wait 3 Months After Corticosteroid Injections to Reduce the Risk of Infection After Total Knee Arthroplasty? J Am Acad Orthop Surg. 2020 Nov 20. doi: 10.5435/JAAOS-D-20-00850. Epub ahead of print. PMID: 33229905.