Gallo Jirí, Raska Milan, Dendis Milos, Florschütz Anthony V, Kolár Milan
Department of Orthopaedics, Teaching Hospital, Olomouc, Czech Republic.
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2004 Dec;148(2):123-9. doi: 10.5507/bp.2004.022.
Prosthetic joint infection (PJI) diagnosis includes several classes of verification. Among them, only a few have a stronger independent value, namely intraarticular purulence and communicating fistulas. Other diagnostic methods require careful test combinations, analysis, and interpretation. Molecular based techniques using the polymerase chain reaction (PCR) seem to be a promising PJI diagnostic modality due to its excellent sensitivity, specificity, positive predictive value, and speed. Most of the recent reviewers are in agreement that molecular diagnosis has enough potential for future application in orthopaedics even if there are only a few heterogeneous studies fully supporting this concept. Conversely, at least one study has been published with significantly worse results (sensitivity and specificity less than 0.75). The lack of supporting evidence in the published studies may be closely related to varying PCR laboratory procedures, inappropriate reference standards, and other methodological shortcomings among research centers. It is not yet justifiable to firmly include molecular methods into the present PJI diagnostic schemes. The orthopaedic community must await the results of well-organized ongoing studies before considering inclusion of molecular diagnostics as a PJI diagnostic method. The aim of this paper was to make a survey of current PJI molecular diagnostic techniques in orthopaedics.
人工关节感染（PJI）的诊断包括几类验证方法。其中，只有少数具有较强的独立价值，即关节内化脓和交通性瘘管。其他诊断方法需要仔细的检测组合、分析和解读。基于聚合酶链反应（PCR）的分子技术因其出色的敏感性、特异性、阳性预测值和速度，似乎是一种很有前景的PJI诊断方式。大多数近期的综述都认为，即使只有少数异质性研究充分支持这一概念，分子诊断在骨科未来应用中仍有足够的潜力。相反，至少有一项研究发表的结果明显更差（敏感性和特异性低于0.75）。已发表研究中缺乏支持证据可能与各研究中心PCR实验室程序不同、参考标准不当以及其他方法学缺陷密切相关。将分子方法坚定地纳入当前的PJI诊断方案尚不具有合理性。骨科界在考虑将分子诊断作为PJI诊断方法之前，必须等待正在进行的组织良好的研究结果。本文的目的是对当前骨科中PJI分子诊断技术进行综述。
