髋关节翻修术中冰冻病理切片与 ^(99)Tc^m三相同位素骨扫描共用诊断髋关节假体周围感染  

Intraoperative frozen section analysis and ^(99)Tc^m triplephase bone scanning for diagnosing periprosthetic infection in hip

作　　者：张炅[1] 王毅[1] 冯建民[1] 宋艳艳[1] 刘志宏[1] 何川[1] 

机构地区：[1]上海交通大学医学院附属瑞金医院骨科,上海市伤骨科研究所,上海市中西医结合防治骨与关节病损重点实验室,上海交通大学基础医学院生物统计学教研室

出　　处：《中国组织工程研究》2014年第31期4921-4928,共8页Chinese Journal of Tissue Engineering Research

基　　金：上海交通大学医学院科技基金项目(13XJ1003)~~

摘　　要：背景:常规血清学、影像学和实验室诊断方法诊断假体周围感染难以达到理想的灵敏度、特异度和准确性。尤其对于假体置换后晚期假体低毒性感染性松动和无菌性松动之间的鉴别诊断还缺乏普遍接受的诊断标准。术前、术中和术后多种诊断方法的联合运用对于明确感染诊断和制定手术翻修策略有重要的临床意义。目的:通过初次髋关节置换后翻修术前和术中联合运用99Tcm三相同位素骨扫描和冰冻病理切片多形核白细胞计数方法诊断髋关节假体周围感染,并与常规诊断手段相比较。方法:2008年4月至2013年5月共收治44例髋关节置换后翻修病例,结合临床症状和血清学检查指标,18例患者血沉和C-反应蛋白增高诊断为临床怀疑感染病例组;26例血清学指标正常诊断为临床怀疑无菌性松动病例组。所有患者翻修前进行99Tcm三相同位素骨扫描检查,同时结合翻修手术过程中组织冰冻病理切片结果。如两项结果均为阴性,诊断为假体无菌性松动,行一期翻修手术;反之则诊断为假体周围感染,行二期手术翻修。通过术后临床随访血清学指标及手术疗效,采用受试者工作曲线的统计学方法评估联合运用99Tcm三相同位素骨扫描和组织冰冻病理切片的诊断价值。结果与结论:18例临床感染病例组中16例患者术前99Tcm三相同位素骨扫描结果和术中冰冻病理结果均为阳性,诊断为感染,二期翻修;2例结果均阴性,排除感染,一期翻修。26例松动病例组中,25例术前99Tcm三相同位素骨扫描结果和术中冰冻病理结果阴性,诊断为无菌性松动,一期翻修;1例患者术后病原菌微生物学培养送检3个标本中1个标本培养出金黄色葡萄球菌,诊断为假体周围感染,仍采取一期翻修。增加99Tcm三相同位素骨扫描和冰冻病理切片多形核白细胞计数的方法后,工作特征曲线面积由0.906上升至0.972,感染诊断灵敏度由89%�BACKGROUND：Conventional serological, imaging and laboratory diagnosis methods for diagnosing periprosthetic infection are difficult to achieve ideal sensitivity, specificity and accuracy. In particular, the differential diagnosis of septic loosening and aseptic loosening in late stage after prosthetic replacement lacks of commonly accepted diagnostic criteria. The combination of preoperative, intraoperative and postoperative diagnostic methods is of great significance in the identifying infection diagnosis and formulating renovation strategy. OBJECTIVE：To diagnose periprosthetic hip joint infection by combined use of preoperative 99Tcm triplephase bone scanning and intraoperative neutrophil count in frozen section analysis, and to compare with conventional diagnostic tools. METHODS：Between April 2008 and May 2013, 44 hip revision cases were enrol ed. Combined with clinical symptoms and serological examination, 18 cases whose erythrocyte sedimentation rate and C-reactive protein increased were considered as clinical y suspected infection group;26 cases with normal serological examination were considered as clinical y suspected aseptic loosening group. 99Tcm triplephase bone scanning was performed in al patients, and combined with intraoperative frozen section analysis. If both results were negative, the diagnosis was aseptic loosening and did one-stage revision surgery;otherwise, periprosthetic infection was detected and two-stage revision surgery was conducted. By postoperative fol ow-up serological indexes and surgery outcomes, statistics of work curve of subjects was used to evaluate the diagnostic values of 99Tcm triplephase bone scanning and frozen section analysis. RESULTS AND CONCLUSION：In 18 cases of clinical y suspected infection group, 16 cases of preoperative 99Tcm triplephase bone scanning and intraoperative frozen section results were positive, so two-stage revision surgeries were performed;2 cases with negative results received one-stage revision surgery after excluding infection. In 26 case

关 键 词：植入物 人工假体 翻修 骨扫描 冰冻切片 诊断 关节成形 感染 松动 

分 类 号：R318[医药卫生—生物医学工程]