Pandey R, Drakoulakis E, Athanasou N A
Department of Orthopaedic Surgery, Nuffield Orthopaedic Centre, Oxford, UK.
J Clin Pathol. 1999 Feb;52(2):118-23. doi: 10.1136/jcp.52.2.118.
To characterise the number and nature of the inflammatory cells seen in cases of septic or aseptic loosening of hip arthroplasty, and to establish reliable histological criteria to distinguish between these two conditions.
Histological examination of paraffin sections of periprosthetic tissues (pseudocapsule, femoral and acetabular pseudomembranes) of 523 cases of aseptic loosening and 79 cases of microbiology culture proven septic loosening. The cellular composition of the inflammatory cell infiltrate was determined semiquantitatively.
The finding of a 2+ or greater neutrophil polymorph infiltrate (one or more cells per high power field (x400) on average after examination of 10 fields) in arthroplasty tissues correlated strongly with the microbiological diagnosis of septic loosening: diagnostic sensitivity 100%, specificity 97%, accuracy 99%, positive predictive value 92%, negative predictive value 100%. The finding of a 3+ neutrophil polymorph infiltrate (five or more cells on average per high power field) had a diagnostic sensitivity of 72%, specificity 100%, accuracy 98%, positive predictive value 100%, and negative predictive value 97%. In some cases of septic loosening the finding of a heavy lymphocytic and plasma cell infiltrate was of low diagnostic sensitivity. A neutrophil polymorph infiltrate (generally less than one cell per 10 high power fields) was also seen in cases of aseptic loosening.
The presence of 2+ or more (more than one neutrophil polymorph per high power field (x400) on average after examination of at least 10 high power fields) in periprosthetic tissues provides the most sensitive and accurate histopathological criterion for distinguishing between septic and aseptic loosening of hip arthroplasty.
描述髋关节置换术后感染性或无菌性松动病例中所见炎性细胞的数量和性质，并建立可靠的组织学标准以区分这两种情况。
对523例无菌性松动和79例经微生物培养证实的感染性松动的假体周围组织（假包膜、股骨和髋臼假膜）石蜡切片进行组织学检查。对炎性细胞浸润的细胞组成进行半定量测定。
在关节置换组织中发现2+或更高的中性多形核白细胞浸润（在检查10个视野后平均每个高倍视野（×400）有一个或更多细胞）与感染性松动的微生物学诊断密切相关：诊断敏感性为100%，特异性为97%，准确性为99%，阳性预测值为92%，阴性预测值为100%。发现3+中性多形核白细胞浸润（平均每个高倍视野有五个或更多细胞）的诊断敏感性为72%，特异性为100%，准确性为98%，阳性预测值为100%，阴性预测值为97%。在一些感染性松动病例中，大量淋巴细胞和浆细胞浸润的诊断敏感性较低。在无菌性松动病例中也可见中性多形核白细胞浸润（通常每10个高倍视野少于一个细胞）。
假体周围组织中存在2+或更多（在至少检查10个高倍视野后平均每个高倍视野（×400）有一个以上中性多形核白细胞）为区分髋关节置换术后感染性和无菌性松动提供了最敏感和准确的组织病理学标准。
