人工关节周围感染的定义：是否存在共识？
Definition of periprosthetic joint infection: is there a consensus?
机构信息
The Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
出版信息
Clin Orthop Relat Res. 2011 Nov;469(11):3022-30. doi: 10.1007/s11999-011-1971-2.
BACKGROUND
The diagnosis of periprosthetic joint infection (PJI) continues to pose a challenge. While many diagnostic criteria have been proposed, a gold standard for diagnosis is lacking. Use of multiple diagnostic criteria within the joint arthroplasty community raises concerns in patient treatment and comparison of research pertaining to PJI.
QUESTIONS/PURPOSES: We (1) determined the variation in existing diagnostic criteria, (2) compared the existing criteria to a proposed new set of criteria that incorporates aspirate cell count analysis, and (3) investigated the variations between the existing criteria and the proposed criteria.
PATIENTS AND METHODS
We retrospectively identified 182 patients undergoing 192 revision knee arthroplasties who had a preoperative joint aspiration analysis at our institution between April 2002 and November 2009. We excluded 20 cases due to insufficient laboratory parameters, leaving 172 cases for analysis. We applied six previously published sets of diagnostic criteria for PJI to determine the variation in its incidence using each set of criteria. We then compared these diagnostic criteria to our proposed new criteria and investigated cases where disagreement occurred.
RESULTS
We identified 41 cases (24%) in which at least one established criteria set classified the case as infected while at least one other criteria set classified the case as uninfected. With our proposed criteria, the infected/uninfected ratio was 92/80. The proposed criteria had a large variance in sensitivity (54%-100%), specificity (39%-100%), and accuracy (53%-100%) when using each of the established criteria sets as the reference standard.
CONCLUSIONS
The discrepancy between definitions of infection complicates interpretation of the literature and the treatment of failed TKAs owing to PJI. Based on our findings, we suggest establishing a common set of diagnostic criteria utilizing aspirate analysis to improve the treatment of PJI and facilitate interpretation of the literature.
LEVEL OF EVIDENCE
Level III, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
人工关节置换术后感染（PJI）的诊断仍然具有挑战性。尽管已经提出了许多诊断标准，但缺乏金标准。关节置换领域中使用多种诊断标准会引起患者治疗和 PJI 相关研究比较方面的担忧。
问题/目的：我们（1）确定了现有的诊断标准的差异，（2）将现有的标准与一组新的标准进行比较，该标准纳入了抽吸物细胞计数分析，（3）研究了现有标准与新提出的标准之间的差异。
患者和方法
我们回顾性地确定了在我们机构于 2002 年 4 月至 2009 年 11 月之间进行 192 例翻修膝关节置换术的 182 例患者，这些患者术前进行了关节抽吸分析。由于实验室参数不足，我们排除了 20 例病例，留下 172 例病例进行分析。我们应用了六组先前发表的 PJI 诊断标准，以确定使用每组标准时的发病率差异。然后，我们将这些诊断标准与我们提出的新标准进行比较，并研究了出现分歧的病例。
结果
我们发现，在至少一组已建立的标准中，至少有 41 例（24%）病例被归类为感染，而在至少一组其他标准中，至少有 41 例（24%）病例被归类为未感染。使用我们提出的标准，感染/未感染的比例为 92/80。当使用每种已建立的标准组作为参考标准时，提出的标准的灵敏度（54%-100%）、特异性（39%-100%）和准确性（53%-100%）差异较大。
结论
感染定义之间的差异使文献解读和 PJI 导致的失败 TKA 治疗复杂化。基于我们的发现，我们建议建立一套利用抽吸分析的共同诊断标准，以改善 PJI 的治疗并促进文献解读。
证据水平
三级，诊断研究。有关证据水平的完整描述，请参见作者指南。
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