低毒性感染性骨不连术前诊断标准的建立  

Establishment of preoperative diagnosis of low-grade infectious nonunion

作　　者：宋文奇[1] 陆晟迪[1] 徐铮宇[1] 陈华[1] 韩培[1] 郑宪友[1] 康庆林[1] 傅士平 张长青[1] Song Wenqi;Lu Shengdi;Xu Zhengyu;Chen Hua;Han Pei;Zheng Xianyou;Kang Qinglin;Fu Shiping;Zhang Changqing(Department of Orthopaedics,The Sixth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200233,China;Department of Orthopaedics,The Eighth People's Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200235,China)

机构地区：[1]上海交通大学附属第六人民医院骨科,200233 [2]上海交通大学附属第八人民医院骨科,200235

出　　处：《中华创伤骨科杂志》2020年第5期390-393,共4页Chinese Journal of Orthopaedic Trauma

摘　　要：目的探讨血液学检测指标结合核素扫描(骨三相显像)作为低毒性感染性骨不连术前诊断的可靠性。方法回顾性分析2010年6月至2019年6月在上海交通大学附属第六人民医院骨科及上海交通大学附属第八人民医院骨科的265例进行骨不连治疗的患者资料,男151例,女114例;年龄19~64岁,平均39.7岁;骨不连部位主要为胫骨(113例)和股骨(72例)。收集患者术前白细胞计数(WBC)、红细胞沉降率(ESR)、C反应蛋白(CRP)及术前核素扫描结果。以术中病理观察结果为"金标准",分析各项血液学检测指标与核素扫描的敏感性、特异性、受试者工作特征(ROC)曲线下面积(AUC)及Youden指数,以及核素扫描结果结合单项及多项血液学检测指标的敏感性、特异性、AUC及Youden指数。结果核素扫描与术中病理比较敏感度80.7%,特异度73.3%,AUC 0.770,Youden指数0.540。核素扫描若结合1项血液学检测指标,最大AUC是核素扫描与CRP结合,为0.683,此时敏感性为98.0%,特异度为70.3%,其Youden指数0.848。核素扫描若结合2项血液学检测指标,最大AUC是与WBC、ESR结合,为0.895,此时敏感性为94.3%,特异度为67.3%,Youden指数0.616;三组数据AUC均超过0.880。核素扫描结合3项血液学检测指标后,敏感性为96.5%,特异性为79.7%,AUC为0.925,Youden指数为0.762。结论血液学检测指标结合核素扫描可作为低毒性感染性骨不连诊断的可靠依据。Objective To explore the reliability of preoperative diagnosis of low-grade infectious nonunion using haematological testing and radioisotope scanning(bone 3-phase image).Methods A retrospective study was conducted of the 265 patients with bone nonunion who had been treated at Department of Orthopaedics,The Sixth People’s Hospital Affiliated to Shanghai Jiaotong University and at Department of Orthopaedics,The Eighth People’s Hospital Affiliated to Shanghai Jiaotong University from June 2010 to June 2018.They were 151 males and 114 females,aged from 19 to 64 years(average,39.7 years).The nonunions occurred mainly at the tibia(113 cases)and the femur(72 cases).The preoperative results of their white blood cell count(WBC),erythrocyte sedimentation rate(ESR),C-reactive protein(CRP)and radioisotope scanning were recorded.Taking the intraoperative pathological observations as the gold standards,the sensitivity,specificity,area under curve(AUC)of receiver operator characteristic(ROC)and Youden index were statistically analyzed respectively for every preoperative haematological tests and radioisotope scanning as well as for different combinations of the radioisotope scanning and one or more haematological tests.Results Compared with the pathological observations,the radioisotope scanning showed a sensitivity of 80.7%,a specificity of 73.3%,an AUC of 0.770 and a Youden index of 0.540.In the combinations of radioisotope scanning and one haematological test,that of radioisotope scanning and CRP produced the largest AUC of 0.683,a sensitivity of 98.0%,a specificity of 70.3%,and a Youden index of 0.848.In the combinations of radioisotope scanning and 2 haematological tests,that of radioisotope scanning and WBC and ESR produced the largest AUC of 0.895,a sensitivity of 94.3%,a specificity of 67.3%,and a Youden index of 0.616 and all the 3 ones yielded an AUC of more than 0.880.The combination of radioisotope scanning and all the 3 haematological tests produced a sensitivity of 96.5%,a specificity of 79.7%,an AUC of 0.925

关 键 词：感染 骨折 不愈合 C反应蛋白 核素扫描 

分 类 号：R687[医药卫生—骨科学]