人工关节置换术后假体周围感染诊断方法的研究进展  

Recent developments in diagnosis of periprosthetic joint infection

作　　者：李睿[1] 陈继营[1] 

机构地区：[1]解放军总医院骨科,北京100853

出　　处：《中华骨科杂志》2016年第19期1254-1262,共9页Chinese Journal of Orthopaedics

基　　金：国家自然科学基金（81672192）

摘　　要：假体周围感染是人工关节置换术后灾难性的并发症,目前已成为膝关节翻修的首要原因及髋关节翻修的第三位原因.而对翻修患者,假体周围感染的正确诊断对治疗方法的选择至关重要.但目前没有任何一种单一的检查同时具有较好的敏感性及特异性.在诊断方法中,经典的诊断技术如包括红细胞沉降率、C反应蛋白在内的血清学检测,关节液白细胞计数及中性粒细胞百分比,细菌培养,组织病理学检查仍具有不可替代的作用.另一些较新的诊断技术,如白细胞酯酶试纸测定,具有快速、准确、简便和经济的优点.以α-防御素为代表的关节液标记物具有极高的敏感性与特异性,有很好的应用前景.在各种诊断方法中只有细菌培养及药敏结果可以更好地指导治疗,因此提高培养阳性率尤为重要.随着技术的改进,超声裂解及PCR技术在提高培养阳性率方面的作用仍是研究热点.影像学技术近年有很大的改进,如白细胞标记显像、18F-脱氧葡萄糖-正电子发射断层扫描技术等,但大部分方法的作用仍存在争议或处于研究阶段.更加准确、稳定且能大规模应用于临床的检查手段还需进一步探讨和验证.Periprosthetic joint infection （PJI） is a devastating complication after total joint arthroplasty.Currently,PJI is the main cause for knee revision and the third reason for hip revision.Accurate diagnosis is of quite importance for patients with potential in revision surgery.However,there is no test alone can achieve both perfect sensitivity and specificity in diagnosis of PJI.The following diagnostic methods still have irreplaceable role,including erythrocyte sedimentation rate （ESR）,C reactive protein （CRP） test,synovial white blood cell count and polymorphonuclear percentage,bacteria culture and histology analysis.Some novel diagnostic techniques,such as leucocytes esterase strip test,show advantages in diagnosing as fast,convenient and cost-saving.Synovial biomarkers,such as α-defensin,have promising prospect with both high sensitivity and specificity.Among various diagnostic methods,bacteria culture and drug sensitivity test can guide the therapy of PJI.Thus,it is crucial to improve the positive rate of bacteria culture.With the development of technology,sonication and polymerase chain reaction （PCR） will be the future research highlights.Although the imaging technologies,such as labeled leukocyte imaging and 18F-fluorodeoxyglucose positron emission tomography （18F-FDG PET）,have been progressed in the past years,most of them are still in controversy.Further researches are still needed in the future.

关 键 词：人工关节置换术后 假体周围感染 诊断方法 正电子发射断层扫描技术 组织病理学检查 18F-脱氧葡萄糖 髋关节翻修 细菌培养 

分 类 号：R687.4[医药卫生—骨科学]