PDF(Pubmed)
Abstract：
Periprosthetic shoulder infection (PSI) remains a challenging complication after shoulder arthroplasty. Therapeutic options include one- or two-stage revision, irrigation and debridement, and resection arthroplasty. With our systematic review and meta-analysis, we aimed to compare one- and two-stage revisions for periprosthetic shoulder joint infections and determine the most appropriate therapeutic procedure. We performed an extensive literature search in PubMed, Ovid Medline, Cochrane Library, Web of Science, and CINAHL and filtered out all relevant studies. The meta-analysis was performed using the random-effects model, heterogeneity was analyzed using I2, and publication bias was assessed using the Egger\'s test. A total of 8 studies with one-stage revisions, 36 studies with two-stage revisions, and 12 studies with both one-stage and two-stage revisions were included. According to the random-effects model, the reinfection rate for the entirety of the studies was 12.3% (95% Cl: 9.6-15.3), with a low-to-moderate heterogeneity of I2 = 47.72%. The reinfection rate of the one-stage revisions was 10.9%, which was significantly lower than the reinfection rate of the two-stage revisions, which was 12.93% (p = 0.0062). The one-stage revision rate was significantly lower with 1.16 vs. 2.25 revisions in the two-stage revision group (p < 0.0001). The postoperative functional outcome in one-stage-revised patients was comparable but not statistically significant (p = 0.1523). In one- and two-stage revisions, most infections were caused by Cutibacterium acnes. In summary, our systematic review and meta-analysis show the superiority of single-stage revision regarding reinfection and revision rates in periprosthetic shoulder joint infection.
摘要：
肩关节置换术后假体周围肩关节感染（PSI）仍然是一个具有挑战性的并发症。治疗选择包括一个或两个阶段的修正，灌溉和清创，和关节切除术.通过我们的系统回顾和荟萃分析，我们的目的是比较一期和两期修复术治疗肩关节假体周围感染的疗效,并确定最合适的治疗方法.我们在PubMed进行了广泛的文献检索，OvidMedline,科克伦图书馆,WebofScience,和CINAHL并过滤掉所有相关研究。使用随机效应模型进行荟萃分析，使用I2分析异质性,并使用Egger检验评估发表偏倚.共有8项研究进行了一阶段的修订，36项研究分为两阶段修订，纳入了12项同时进行一阶段和两阶段修订的研究.根据随机效应模型，整个研究的再感染率为12.3％（95％Cl：9.6-15.3），具有I2=47.72%的中低异质性。一期修订的再感染率为10.9%,显着低于两阶段修订的再感染率，为12.93%（p=0.0062）。一阶段翻修率显着降低，为1.16vs.两阶段修订组中有2.25次修订（p<0.0001）。一期修订患者的术后功能结局具有可比性，但无统计学意义（p=0.1523）。在一阶段和两阶段的修订中，大多数感染是由粉刺杆菌引起的。总之,我们的系统评价和荟萃分析显示,单阶段翻修在假体周围肩关节感染的再感染和翻修率方面具有优越性.
