关节穿刺在假体周围感染诊断及治疗中的应用与意义  

Application and significance of joint puncture in the diagnosis and treatment of periprosthetic joint infection

作　　者：李程 Andrej Trampuz Li Cheng;Andrej Trampuz(Department of Orthopaedics, Charité–Universit?tsmedizin Berlin, Berlin 13353,Germany)

机构地区：[1]夏里特柏林大学骨科

出　　处：《中国组织工程研究》2019年第36期5868-5874,共7页Chinese Journal of Tissue Engineering Research

基　　金：国家留学基金委项目([2015]3022)，项目负责人：李程;PRO-IMPLANT基金，项目负责人：李程

摘　　要：背景:假体周围感染的诊断是临床研究的难点和重点。关节穿刺检查是术前诊断假体周围感染的常用方法,由于关节穿刺方便操作和容易普及,近年来很多与关节液相关的检查逐步应用于临床诊断假体周围感染,但是很多方法仍存在争议。目的:综述国内、外有关假体周围感染穿刺液检查诊断方法的最新研究进展。方法:由第一作者检索近10年(2008年至2018年)期间PubMed、WebofScience、CNKI数据库中收录的与关节穿刺液诊断假体周围感染的相关文献。英文检索词“periprostheticjointinfection,prostheticjointinfection,synovialfluid,jointpuncture,articularpuncture”;中文检索词“假体周围感染,人工关节感染,关节液,关节穿刺”。共检索到584篇文献,通过阅读文献题目、摘要以及全文后,52篇文章纳入研究。结果与结论:①术前关节穿刺检查是诊断假体周围感染不可缺少的一部分;②目前还没有能够单独诊断假体周围感染的关节穿刺检查方法,把一些检查方法结合起来使用可提高诊断的准确性;③在超声引导下穿刺,比传统的穿刺方法以及透视下穿刺更有优势;④虽然一些新的诊断方法有一定的优势,但是传统的血培养检查以及白细胞计数仍然是诊断假体周围感染不可替代的一部分。BACKGROUND: The diagnosis of periprosthetic joint infection is one of the difficulties and key points in clinical research. Joint puncture is a commonly used method in the preoperative diagnosis of periprosthetic joint infection, because it is simple and easy to spread. In recent years, synovial fluid examinations have been gradually used in clinical diagnosis, but there remain many disputed issues. OBJECTIVE: To summarize latest research progress of synovial fluid analysis in the diagnosis of periprosthetic joint infection in and outside China. METHODS: Publications in English and Chinese from 2008 to 2018 were searched by the first author for studies regarding joint puncture in the diagnosis of periprosthetic joint infection from the electronic databases of PubMed, Web of Science, and CNKI using the following keywords: periprosthetic joint infection, prosthetic joint infection,synovial fluid, joint puncture, and articular puncture. Five hundred and eighty-four articles were identified by the literature search. By reading the literature title, abstract and full text, 52 studies were included in our review paper. RESULTS AND CONCLUSION:(1) Preoperative joint puncture is an indispensable part of the diagnosis of periprosthetic joint infection.(2) Until now, there is no single test that can diagnose periprosthetic joint infection alone;however, combining several examination methods can improve diagnostic accuracy.(3) Joint puncture under ultrasonic guidance has several advantages over fluoroscopy and standard methods.(4) Although several new methods have certain advantages in the diagnosis of periprosthetic joint infection, conventional testing of blood culture bottles and leukocyte counts still have an irreplaceable role in the diagnosis of periprosthetic joint infection.

关 键 词：关节置换术 人工关节 置换 术后并发症 感染 假体周围感染 关节穿刺 关节液 诊断 方法 

分 类 号：R459.9[医药卫生—治疗学] R604[医药卫生—临床医学]