假体周围感染三种样本处理病原体检测效能比较  

Comparison of the pathogen detection efficiency of three sample treatments in periprosthetic joint infection

作　　者：葛无非 张贤祚 朱晨[1] GE Wu-fei;ZHANG Xian-zuo;ZHU Chen(Anhui Provincial Hospital Affiliated to Anhui Medical University,Hefei 230722,China)

机构地区：[1]安徽医科大学附属安徽省立医院,安徽合肥230722

出　　处：《中国矫形外科杂志》2021年第9期804-808,共5页Orthopedic Journal of China

摘　　要：[目的]比较假体周围感染三种样本处理的病原检测效能。[方法]回顾性分析2018年12月~2020年1月本院收治的人工髋膝关节翻修手术病例。同时对术中采集的关节液、假体周围组织匀浆和假体超声震荡液进行培养,以检测病原体。计算每种方法的敏感性、特异性、阳性预测值和阴性预测值,并对培养的微生物谱进行比较。[结果]检出敏感性由高至低依次为:超声震荡液(77.01%)>组织匀浆(60.92%)>关节液(32.18%),三者间差异有统计学意义(P<0.05),但三者间的特异性、阳性预测值和阴性预测值的差异均无统计学意义(P>0.05)。87例假体周围感染患者中,47例在标本采集前的2周内使用了抗生素,40例未使用抗生素。与未使用抗生素组相比,使用抗生素组的关节液(40.00%vs 25.53%,P<0.05)和组织匀浆(70.00%vs 53.19%,P<0.05)的检出敏感性显著降低(P<0.05);但是否使用抗生素对超声震荡液的检出敏感性无显著影响(77.50%vs 76.60%,P>0.05)。相比较于关节液培养较为单一的微生物谱,组织匀浆和超声震荡液可检出少见致病微生物和混合微生物。[结论]假体周围组织匀浆培养和假体超声震荡液培养能够有效提高假体周围感染致病微生物检出的敏感性,在术前使用抗生素干扰的条件下假体超声震荡液培养的优势更为明显。[Objective]To compare the pathogen detection efficiency of the three sample treatments for periprosthetic joint infection(PJI).[Methods]A retrospective study was done on the patients who underwent hip or knee revision arthroplasty in our hospital from December 2018 to January 2020.The intraoperatively collected synovial fluid,homogenate of the tissue around the prosthesis,and the ultrasonic oscillating fluid of prosthesis of every patient were cultured simultaneously for the detection of pathogen.The sensitivity,specificity,positive predictive value and negative predictive value of the three methods were calculated,and the microbial spectrums of culture were compared.[Results]The sensitivity of pathogen detection ranked up-down in sequence of ultrasonic oscillating fluid(77.01%)>tissue homogenate(60.92%)>synovial fluid(32.18%),among which there was statistically significant difference(P<0.05).However,the differences in specificity,positive predictive value and negative predictive value among the three treatments were not statistically significant(P>0.05).Among 87 patients with PJI,47 patients received antibiotics within 2 weeks before specimen collection,whereas 40 patients were not given antibiotics.Compared with those who had no antibiotics used,the detection sensitivity of synovial fluid(40.00%vs 25.53,P<0.05)and tissue homogenate(70.00%vs 53.19%,P<0.05)in the patients who had received antibiotics significantly decreased(P<0.05),nevertheless,whether antibiotics were used had no significant effect on the detection sensitivity of ultrasonic oscillating fluid(77.50%vs 76.60%,P>0.05).Compared with the synovial fluid,which cultured a relatively simple microbial spectrum,tissue homogenate and ultrasonic oscillating fluid detected rare pathogenic microorganisms and mixed microorganisms.[Conclusion]The homogenate of the tissue around the prosthesis and the ultrasonic oscillating fluid of prosthesis effectively improve the detection sensitivity of pathogenic microorganisms in PJI.This advantage is more obvious in the u

关 键 词：假体周围感染 关节液 组织匀浆 超声震荡液 

分 类 号：R687.4[医药卫生—骨科学]