关节置换术后假体周围感染诊断的研究进展

Research progress in diagnosis of periprosthetic joint infection after arthroplasty

假体周围感染(Periprosthetic joint infection,PJI)是人工关节置换术后最严重的并发症,及早明确诊断对PJI的治疗意义重大。目前对于PJI的诊断,临床尚无特异性的有效方法,经典的诊断措施包括C反应蛋白(C-reactive protein, CRP)、红细胞沉降率(Erythrocyte sedimentationtate, ESR)在内的血清生物学标志物检测,关节滑膜液WBC计数、多形核中性粒细胞百分比,以及组织病理学检查仍然发挥着不可替代的作用。但随着每年进行的关节置换术数量的上升和病例信息获取渠道的通畅,越来越多的假体关节感染的诊断方法也被提出,本文围绕近年来学界在PJI诊断上提出的标准,从血液样本、滑膜液样本、微生物及病理、影像学等方面对PJI的研究进展进行综述。相关文献结果提示,近年来引起关注的α-防御素、白细胞酯酶为代表的关节滑液标志物具有极高的诊断价值,但也有局限性;术中冰冻切片灵敏度及特异度较高,但容易受主观因素影响;而超声处理、核成像技术及分子测序技术因成本高昂及操作复杂难以大规模实践运用。更加简便、准确、稳定且应用性强的检查手段还需进一步探讨和验证。

Prosthesis joint infection(PJI)is the most serious complication after artificial joint replacement surgery.Early diagnose is of great significance for the treatment of PJI.Currently,there is no specific and effective method for the diagnosis of PJI.Classic diagnostic measures include detection of serum biological markers such as CRP and ESR,WBC count in synovial fluid,percentage of polymorphonuclear neutrophils(PMN%)in synovial fluid,and histopathological examination.They still play an irreplaceable role.However,with the increase in the number of joint replacement surgeries performed each year and the smooth access to case information,more and more diagnostic methods for prosthetic joint infections have also been proposed.This article will focus on the standards proposed by the academic community in recent years in the diagnosis of PJI,review the research progress of PJI from the perspectives of blood samples,synovial fluid samples,microbiology and pathology,imaging,and other aspects.According to the results of relevant literature,it is suggested that in recent years,attention has been paid to the joint synovial fluid markers represented byα-defensins and leukocyte esterases,which have high diagnostic value,but there are still still some limitations.The sensitivity and specificity of intraoperative frozen sections are high,and they are easily influenced by subjective factors.However,ultrasound processing,nuclear imaging technology,and molecular sequencing technology are difficult to apply on a large scale due to their high cost and complex operation.Further exploration and verification are needed for more simple,accurate,stable,and applicable inspection methods.