谈谈关节假体周围感染的诊断问题

Diagnosis of periprosthetic joint infection-current situation and progress

关节假体周围感染(periprosthetic joint infection,PJI)是关节置换术后灾难性的并发症。据估计,1%~3%的初次置换患者以及3%~5%的翻修患者会发生PJI [1-5]。根据最新文献报道,感染是膝关节置换术后翻修的首要原因[6-7],是髋关节置换术后翻修的第三或第四大原因[7-8]。随着关节置换手术量的逐年增大,关节翻修将是未来关节外科手术的重要组成部分,PJI的病例量也必将随之逐年上升。

Periprosthetic joint infection(PJI)is a catastrophic complication after joint replacement.Correct diagnosis is a key step for PJI treatment.At present,American association of physicians(AAOS),musculoskeletal infection association(MSIS),American association of infectious diseases(IDSA),ICM on PJI and other international organizations have given their own diagnostic criteria.In September 2018,the second ICM was held again in Philadelphia,and further discussions were conducted on relevant issues.D-dimer,α-defensin and other indicators were added in the new diagnostic criteria.According to the current guidelines,the diagnosis process of PJI can still be divided into symptom and sign assessment,peripheral blood test,diagnostic joint aspiration and intraoperative relative examination.In the future,molecular diagnostic techniques represented by next generation sequencing(NGS)may play an important role.In addition,future studies may focus on the exploration of novel biomarkers and the realization of convenient and rapid diagnosis.This article will review the available diagnostic methods and novel development in the diagnosis of periprosthetic joint infection combined with the 2013 and 2018 ICM criteria.