病理组织学评估在诊断人工关节置换术后假体周围关节感染中的价值

Role of histological evaluation of periprosthetic tissue in diagnosis of periprosthetic joint infection

目的 探讨术后常规病理切片在人工关节置换术后假体周围组织感染诊断中的价值.方法 收集2017年10月至2018年10月北京积水潭医院人工关节置换术后假体周围组织标本145例,其中感染病例23例.感染病例中女性17例,男性6例,年龄39~76岁,平均63岁,膝关节置换术12例,髋关节置换术11例.病理以5个或更多HPF中>5个中性粒细胞/HPF为诊断标准.所有病理切片均经2位病理医师分别独立进行2次审阅,2次审阅时间间隔>2周.对于诊断结果计算灵敏度,特异度,阳性预测值,阴性预测值.计算病理组织学诊断的机遇符合率及Kappa值.结果 假体周围组织关节感染组织中,中性粒细胞可散在分布于滑膜组织内或灶状聚集,伴血管周或血管壁浸润.2位病理医师一致诊断为感染的病例15例,诊断的机遇符合率是91.3%,Kappa值为0.817.病理检测的灵敏度60.9%,特异度100.0%,阳性预测值100.0%,阴性预测值93.1%.结论 病理组织学评估诊断人工关节置换术后感染与临床诊断的符合率较高,且特异度及可重复性较好.

Objective To evaluate the role of histologicalpathology in the diagnosis of periprosthetic joint infection.Methods A total of 145 cases of joint arthroplasty during October 2017 and October 2018 from Beijing Jishuitan Hospital were collected.There were 23 cases of infection,including knee joint arthroplasty(12 cases)and hip arthroplasty(11 cases).There were 17 females and 6 males.Patients′age ranged from 39 to 76 years(mean 63 years).The infection was diagnosed if there were>5 neutrophils per high power field in at least 5 high power field.The permanent sections were examined twice separately by two pathologists,and the interval time of histologic examination was at least two weeks.Sensitivity(SE),specificity(SP),positive predictivevalue(PPV),and negative predictive value(NPV)were calculated.The consistency evaluation of histologic examination of two pathologists was calculated by Kappa analysis.Results The neutrophil cells could locate scattered or focally in the synovium tissue of periprosthetic joint infection.Somewhere,the infiltration of vessel and the perivascular distribution could also exist.Opportunity coincidence rate between two pathologists was 91.3%(Kappa=0.817).The results showed that SE was 60.9%,SP was 100.0%,NPV was 93.1%,PPV was 100.0%.Conclusions The presence of polymorphonuclear cells in histologic examination is correlated with infection.There was high consistency between histologic examination and clinical diagnosis of joint arthroplasty.