Della Valle C J, Scher D M, Kim Y H, Oxley C M, Desai P, Zuckerman J D, Di Cesare P E
Musculoskeletal Research Center, Department of Orthopaedic Surgery, New York University Medical Center-Hospital for Joint Diseases, New York 10003, USA.
J Arthroplasty. 1999 Jun;14(4):500-4. doi: 10.1016/s0883-5403(99)90108-0.
The ability to identify intraoperatively patients with an infected prosthesis at the time of a revision procedure assists the surgeon in selecting appropriate management. The results of 413 intraoperative Gram stains were compared with the results of operative cultures, permanent histology, and the surgeon's intraoperative assessment to determine the ability of Gram stains to identify periprosthetic infection. Gram staining correctly identified the presence of infection in 10 of the 68 cases that met study criteria for infection (sensitivity of 14.7%). Four false-positive Gram stains were encountered. Intraoperative Gram stains do not have adequate sensitivity to be helpful in identifying periprosthetic infection and should not be performed on a routine basis. They may be helpful, however, in cases in which gross purulence is encountered to assist in the selection of initial antibiotic therapy. The use of intraoperative Gram staining alone is inadequate for ruling out infection at the time of revision total joint arthroplasty.
在翻修手术中识别感染假体患者的能力有助于外科医生选择合适的治疗方法。将413例术中革兰氏染色结果与手术培养结果、永久组织学检查结果以及外科医生的术中评估结果进行比较，以确定革兰氏染色识别假体周围感染的能力。在符合感染研究标准的68例病例中，革兰氏染色正确识别出10例存在感染（敏感性为14.7%）。出现了4例假阳性革兰氏染色结果。术中革兰氏染色对识别假体周围感染的敏感性不足，无助于诊断，不应常规进行。然而，在遇到明显脓性分泌物的情况下，它可能有助于选择初始抗生素治疗。仅使用术中革兰氏染色不足以在翻修全关节置换术时排除感染。
