University Podology Clinic, Faculty of Medicine, Universidad Complutense de Madrid, Madrid,Spain.
Diabetes Care. 2010 Oct;33(10):2140-5. doi: 10.2337/dc09-2309. Epub 2010 Jul 9.
To compare the diagnostic characteristics of tests used for a prompt diagnosis of chronic osteomyelitis in the diabetic foot, using bone histology as the criterion standard. The tests assessed were probe-to-bone (PTB), clinical signs of infection, radiography signs of osteomyelitis, and ulcer specimen culture.
A prospective study was performed on patients with foot ulcers referred to our diabetic foot clinic. Ulcer infection was diagnosed by recording clinical signs of infection and taking specimens for culture. The presumptive diagnosis of osteomyelitis was based on these results and the findings of a plain X-ray and PTB test. All patients with a clinical suspicion of bone infection were subjected to surgical treatment of the affected bone. During surgery, bone specimens were obtained for a histological diagnosis of osteomyelitis.
Over 2.5 years, 210 foot lesions were consecutively examined and 132 of these wounds with clinical suspicion of infection selected as the study sample. Of these, 105 (79.5%) lesions were diagnosed as osteomyelitis. Among the tests compared, the best results were yielded by the PTB test including an efficiency of 94%, sensitivity of 98%, specificity of 78%, positive predictive value of 95%, and negative predictive value of 91% (P < 0.001, κ 0.803); the positive likelihood ratio was 4.41, and the negative likelihood ratio was 0.02 (95% CI).
In our outpatient population with a high prevalence of osteomyelitis, the PTB test was of greatest diagnostic value, especially for neuropathic ulcers, and proved to be efficient for detecting osteomyelitis in the diabetic foot.
以骨组织学为标准，比较用于快速诊断糖尿病足慢性骨髓炎的检测手段的诊断特征。评估的检测手段包括探针至骨（PTB）、感染的临床体征、骨髓炎的放射影像学征象，以及溃疡标本培养。
对转诊至我们糖尿病足诊所的足部溃疡患者进行了一项前瞻性研究。通过记录感染的临床体征并采集标本进行培养来诊断溃疡感染。根据这些结果以及普通 X 射线和 PTB 检测结果，对假定的骨髓炎进行诊断。所有疑似骨骼感染的患者均接受受累骨的外科治疗。在手术过程中，获取骨骼标本进行骨髓炎的组织学诊断。
在超过 2.5 年的时间里，连续检查了 210 个足部病变，其中 132 个具有临床感染嫌疑的伤口被选为研究样本。这些伤口中，105 个（79.5%）被诊断为骨髓炎。在比较的检测手段中，PTB 检测的结果最佳，包括 94%的效率、98%的敏感度、78%的特异性、95%的阳性预测值和 91%的阴性预测值（P < 0.001，κ=0.803）；阳性似然比为 4.41，阴性似然比为 0.02（95%CI）。
在我们具有高骨髓炎患病率的门诊人群中，PTB 检测具有最大的诊断价值，特别是对于神经病变性溃疡，并且被证明对检测糖尿病足中的骨髓炎有效。
