髋关节假体感染的实验室与临床诊断对比研究  

Comparative study on laboratory and clinical diagnosis of hip prosthesis infections

作　　者：杨国志[1] 李振武[1] 尹锐峰[1] 李志安[1] 

机构地区：[1]南阳市中心医院骨科二病区,河南南阳473009

出　　处：《中华医院感染学杂志》2015年第2期404-406,共3页Chinese Journal of Nosocomiology

基　　金：河南省卫生厅立项基金资助项目(HW-2010B-017)

摘　　要：目的评价C-反应蛋白(CRP)、血沉(ESR)和术中冰冻切片单独及联合应用对诊断髋关节假体周围感染的作用,以降低漏诊率。方法对2006-2012年收治的髋关节置换翻修的患者进行回顾性分析,以CRP、ESR和术中冰冻切片作为诊断假体周围感染的标准,其中任意两项为阳性者即为感染,结合假体感染的"金标准",采用免疫浊度法测定CRP,ESR采用Westergren法测定,术中冰冻切片采用Feldman标准。结果 CRP的灵敏性、特异性、准确性分别为79.17%、87.50%、83.24%;ESR的灵敏性、特异性、准确性分别为81.94%、93.75%、85.16%;术中冰冻切片的灵敏性、特异性、准确性分别为86.11%、89.58%、87.22%;联合诊断的灵敏性、特异性、准确性分别为97.22%、95.83%、96.47%。结论将CRP、ESR和术中冰冻切片联合起来诊断髋关节假体周围感染可明显提高确诊率。OBJECTIVE To evaluate the effect of single or joint use of C-reactive protein（CRP）,erythrocyte sedimentation rate（ESR）,and intraoperative frozen section on the diagnosis of hip prosthesis infections so as to reduce the rate of misdiagnosis.METHODS The patients who received the hip replacement renovations in the hospital from2006 to 2012were retrospectively analyzed,the CRP,ESR,and intraoperative frozen section were defined as the standards for the diagnosis of the prosthesis infections,the patients were confirmed as the infections when any two of them were tested positive;by the combination with the′gold standards′for diagnosis of the prosthesis infections,the CRP level was determined by using immune turbidity method,the ESR was determined with the use of Westergren method,and the intraoperative frozen section was determined by means of the Feldman standard.RESULTS The sensitivity of the CRP was 79.17%,the ESR 81.94%,the intraoperative frozen section 86.11%;the specificity of the CRP was 87.50%,the ESR 93.75%,the intraoperative frozen section 89.58%;the accuracy of the CRP was 83.24%,the ESR 85.16%,the intraoperative frozen section 87.22%.The sensitivity of the joint diagnosis was 97.22%,the specificity 95.83%,the accuracy 96.47%.CONCLUSIONThe joint application of the CRP,ESR,and intraoperative frozen section can remarkably raise the diagnosis rate of the hip prosthesis infections.

关 键 词：C-反应蛋白 血沉 术中冰冻切片 髋关节置换 感染 

分 类 号：R681.6[医药卫生—骨科学]