组织活检在假体周围感染的诊断中有作用吗？
Is there a role for tissue biopsy in the diagnosis of periprosthetic infection?
机构信息
University College London Hospital, London, UK.
出版信息
Clin Orthop Relat Res. 2010 May;468(5):1410-7. doi: 10.1007/s11999-010-1245-4. Epub 2010 Feb 4.
Abstract
BACKGROUND
Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial.
QUESTIONS/PURPOSES: We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections.
PATIENTS AND METHODS
We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy.
RESULTS
The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.
CONCLUSIONS
Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection.
LEVEL OF EVIDENCE
Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
摘要
背景
成功治疗感染性关节置换术后取决于正确识别致病病原体。术前活检的价值仍存在争议。
问题/目的：我们（1）分别比较和组合这两种检测方法的敏感性和特异性，（2）询问组织活检和抽吸的组合是否会提高我们在评估假体周围关节感染中的诊断效果。
患者和方法
我们前瞻性随访了 120 例疑似全关节置换术后感染的患者：64 例 THA 和 56 例 TKA。所有患者均接受了抽吸培养和活检。
结果
抽吸的敏感性为 83%，活检为 79%，两者联合的敏感性为 90%。抽吸和活检以及两者联合的特异性均为 100%。总的准确性分别为 84%、81%和 90%。
结论
我们的数据表明，组织活检单独使用并不比关节抽吸有明显优势。然而，两种技术的联合使用可提高敏感性和准确性。我们建议在诊断全关节感染时，将组织活检作为关节抽吸的辅助手段。
证据等级
II 级，诊断研究。有关证据水平的完整描述，请参阅作者指南。
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