Levitsky K A, Hozack W J, Balderston R A, Rothman R H, Gluckman S J, Maslack M M, Booth R E
Department of Orthopaedic Surgery, Tufts University School of Medicine, New England Medical Center, Boston, Massachusetts.
J Arthroplasty. 1991 Sep;6(3):237-44. doi: 10.1016/s0883-5403(06)80170-1.
Seventy-two joint arthroplasties undergoing total hip or total knee surgery were studied prospectively with plain radiographs, three-phase bone imaging (3PBI), erythrocyte sedimentation rate (ESR), aspiration of the joint for culture, and multiple intraoperative cultures at the time of revision. Intraoperative cultures and the operative appearance were used to form a diagnosis of definite infection (unequivocal microbiology and gross sepsis), possible infection (positive microbiology or gross sepsis), or no infection (neither positive microbiology nor gross sepsis). For the preoperative diagnosis of infection, as opposed to aseptic loosening, 3PBI alone had a sensitivity of 33% and a specificity of 86%. In conjunction with plain radiographs, minimal improvement in accuracy was seen. A preoperative ESR greater than 30 had low sensitivity (60%) and a specificity of (65%). However, the ESR was statistically significantly higher in the joints with definite infection as compared to those joints without infection. The preoperative joint aspiration had a sensitivity of 67% and a specificity of 96% and, therefore, appears to be the most useful single test in the workup of a painful total joint arthroplasty.
对72例接受全髋关节或全膝关节置换手术的关节成形术患者进行了前瞻性研究，采用了普通X线片、三相骨显像（3PBI）、红细胞沉降率（ESR）、关节穿刺培养以及翻修手术时的多次术中培养。术中培养结果和手术表现用于诊断明确感染（明确的微生物学证据和明显的脓毒症）、可能感染（微生物学阳性或明显的脓毒症）或无感染（微生物学阴性且无明显的脓毒症）。与无菌性松动相对，仅3PBI对感染的术前诊断敏感性为33%，特异性为86%。与普通X线片联合使用时，准确性仅有轻微提高。术前ESR大于30时，敏感性较低（60%），特异性为65%。然而，与无感染的关节相比，明确感染的关节ESR在统计学上显著更高。术前关节穿刺的敏感性为67%，特异性为96%，因此，它似乎是评估疼痛性全关节置换术最有用的单项检查。
