髋关节翻修手术中用于感染诊断的术中采集样本的冰冻切片。
Frozen sections of samples taken intraoperatively for diagnosis of infection in revision hip surgery.
作者信息
Nuñez Leandro V, Buttaro Martín A, Morandi Ana, Pusso Rodolfo, Piccaluga Francisco
机构信息
Institute of Orthopedics Carlos E. Ottolenghi, Hospital Italiano de Buenos Aires, Argentina.
出版信息
Acta Orthop. 2007 Apr;78(2):226-30. doi: 10.1080/17453670710013726.
BACKGROUND
The diagnosis of a suspected infected prosthesis is often difficult, but is important for the choice of treatment. Even at surgery, it is not easy to assess whether the prosthesis is infected or not--even though this may be important for the choice of surgical procedure.
PATIENTS AND METHODS
We assessed the sensitivity, specificity, predictive value, and reliability of the results of the analysis of frozen sections from samples of tissues taken during revision hip surgery of 136 probably infected prostheses. Samples of tissues were taken to be analyzed immediately from frozen sections, to be processed on a routine basis later, and to be referred for bacteriological cultures. A finding of 5 or more polymorphonuclear leukocytes per field at a magnification of 400x was considered positive for infection.
RESULTS
The analysis of frozen sections for infection was in agreement with the results of routine histopathology in 134 of 136 cases. Comparison with the results of culture showed a sensitivity of 85%, a specificity of 87%, a PPV of 79%, an NPV of 91%, and a Kendall's tau correlation coefficient of 0.72.
INTERPRETATION
We believe that the method we have tested is of value in revision surgery when infection cannot be ruled out.
背景
疑似感染假体的诊断通常很困难，但对于治疗方案的选择至关重要。即使在手术时，评估假体是否感染也并非易事——尽管这可能对手术方式的选择很重要。
患者与方法
我们评估了136个可能感染的假体在髋关节翻修手术中所取组织样本冰冻切片分析结果的敏感性、特异性、预测价值和可靠性。组织样本立即取自冰冻切片进行分析，随后进行常规处理，并送去做细菌培养。在400倍放大倍数下，每视野发现5个或更多多形核白细胞被视为感染阳性。
结果
136例病例中，134例冰冻切片感染分析结果与常规组织病理学结果一致。与培养结果比较显示，敏感性为85%，特异性为87%，阳性预测值为79%，阴性预测值为91%，肯德尔tau相关系数为0.72。
解读
我们认为，在无法排除感染的翻修手术中，我们所测试的方法具有价值。
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